Hygiene, Environment & Autoimmunity with Moises Manoff – Author of Epidemic of Absence – Episode 23

Dr. Ruscio interviews Moises Manoff, author of Epidemic of Absence, in this episode of Dr. Ruscio Radio. Moises has written extensively, mostly on science and environment, for podcast-artwork newThe Christian Science Monitor. They discuss a new way to look at autoimmune disease by combining information from our past with 21st century scientific research.


Moises Manoff bio/episode intro…..1:21
Autoimmune conditions and the environment…..8:12
Autoimmune epidemic…..10:03
Hygiene and modern medicine is not always bad…..11:56
Reconciling good vs. bad exposures…..24:19
Strategies to boost immunity…..31:42
Episode wrap-up…..42:20

  1. (38:45) http://www.ncbi.nlm.nih.gov/pubmed/19076246 Trusted SourcePubMedGo to source
  2. http://www.ncbi.nlm.nih.gov/pubmed/22287135 Trusted SourcePubMedGo to source
  3. http://www.ncbi.nlm.nih.gov/pubmed/18538018 Trusted SourcePubMedGo to source
  4. https://drruscio.com/treatments-of-hashimoto/
  5. http://www.moisesvm.com/

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Hygiene, Environment & Autoimmunity with Moises Manoff – Author of Epidemic of Absence

Welcome to Dr. Ruscio Radio, discussing the cutting edge of health, nutrition, and functional medicine. To make sure you’re up today on this and other important topics, visit DrRuscio.com and sign up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.

The following discussion is for educational purposes only, and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking to your doctor.

Now, let’s head to the show!

Dr. Michael Ruscio: Hey, folks. Welcome to Dr. Ruscio Radio. This is Michael Ruscio and I am here with Moises, who is the author of a fantastic book entitled ‘An Epidemic of Absence: A new way of understanding allergies and autoimmune diseases’. I read this book awhile back and though it was fantastic; I cannot recommend enough. If you are someone who is trying to better understand how environment affects your immune system, allergy, and autoimmunity. So, with that, Moises, welcome to the show.

Moises Manoff: Thanks for having me. Great to be here.

Moises Manoff bio/episode intro

DR: Can you tell folks a little bit about yourself, your background, and what motivated you to write this book.

MM: I’m a science journalist now; my most recent career. The motivation was basically my own experience, my own life, my own diseases deal with for most of my life, for as long as I can remember. I’ve had asthma, allergies for my whole life. (I’ve) been allergic to peanuts and sesame for as long as I can remember. I had asthma that I mostly grew out of in adulthood – as a kid it was pretty severe. But then I had this autoimmune disease called alopecia areata, which is hair loss – your immune system attacks your hair follicles. In my case, it left me basically totally hairless by around age 13-14, around there.

So, it’s just been a constant issue in my life. And I’ve always wondered about it. And then as a budding science writer, I started asking the question in a more rigorous way: Why? Have the figured anything out since I was a kid? The truth is, in terms of treatments, they really haven’t. That’s actually last year that that has changed. There is a report of two people with alopecia areata uber colis, which is complete hair loss, took an immune-suppressant drug originally developed for an autoimmune arthritis. Their hair completely grew back. It was pretty amazing.

DR: Interesting.

MM: But that drug has some potentially serious side effects, because it is suppressing an important arm of your immune system. At any case, this hadn’t happened yet when I started writing my book. I started looking into what scientists were thinking about it, and the first thing you come across, basically, is that there is wide-spread recognition that all of the diseases I mentioned, and many, many more – as a class, they are immune mediated diseases; these are diseases in which your immune system is not working quite right. It’s making a mistake of one sort or another. In allergies, it’s attacking a protein like pollen or cat dander, autoimmune diseases attacking your own tissues. We normally think of the immune system as defending us against viruses and bacteria and parasites. But, (in) this case it’s not working quite right, and these diseases have increased pretty dramatically in the last 60 years. Usually, it’s the mid-20th Century is when the epidemic begins. In reality, it begins earlier than that, but we can get into that later.

So anyways, I started looking into this and that’s what I found. And what I found were not very convincing explanation for this increase – you know, pollution, but pollution has gone down since the 70s, at least air-borne pollution; there are vitamin D hypothesis, but really the epidemic of rickets was in the late 19th Century, before this other epidemic began. It’s not that vitamin D isn’t important. I’m sure it is. But, is it really responsible for this?

And then there was what has historically been called the hygiene hypothesis, which is a horrible phrase, and many scientists are lobbying unsuccessfully to have it changed because it’s not indicative of what it means. The hygiene hypothesis – the phrase comes from a paper in which that phrase is never mentioned, from 1989. It’s a paper by a British epidemiologist, David Strachan, who found, simply, that in this gigantic sample size of Britains – I think it was, like, 17,000; I don’t remember. Anyway, he looked at their childhood circumstances and their adult risk of hay fever. He found that the one factor of the many that he looked at – and he looked at nearly 20 (thousand), as I recall – the one factor that predicted hay fever in adulthood was how many kids were in the house. So if you were the fifth-born kid – in other words, if you have four other siblings – your chances of hay fever were much, much lower than if you were an only child. So, among only-children, it was, like, 20 percent had hay fever. And among fifth-born or fourth-born, it was far, far lower. It’s been a while since I read that paper, but people can look it up.

DR: Sure, sure.

MM: So, he proposed – David Strachan proposed – that it was infections. So, if you are in a house with a lot of other kids, there are a lot more colds and that sort of thing going around. Long story short, it turned out very likely not to be infections. It turned out probably that phenomenon, which has been observed elsewhere, turned out to be most likely sharing of beneficial microbes, possibly, or sharing of certain kinds of fecal oral infections, possibly. And possibly certain infections that are chronic in nature, like certain viral infections – I mean, no one is really sure yet.

DR: Sure.

MM: So the idea is simply this – a lot of people have heard of the microbiome, and this is the first indication before anyone had heard of the microbiome, that the microbiome was important. And what was likely happening with these later-born kids is that they are acquiring a robust, healthy, diverse microbiome early in life, and that protects them from allergic disease. That’s one of the things that is probably happening in that case. I just told you probably about 25 years of evolution of the evolution of the hygiene hypothesis, which is a horrible phrase, and which…here are some other possible better phrases, like the Old Friends hypothesis, which comes from a scientist called Graham Rook. He uses this because the microorganisms, and even macro organisms like multi-cellular parasites that matter, are what he calls “Old Friends.” They are organisms that have been with us for a long, long time. They train our immune system in a way that prevents all of these diseases.

DR: Sure.

MM: There’s a microflora hypothesis, which is basically what I said. (There is) the Disturbed Microbiome hypothesis. Martin Blaser now has a Missing Microbes hypothesis, which is pretty self-evident what that means – you’re missing certain key microbes. And so on. So, there is a very long answer to your question.


Autoimmune conditions and the environment

DR: No, you provide a nice lead-in to the whole conversation. Just to briefly give people an orientation here: the environment has a very strong impact on immune-mediated conditions like asthma, allergies, and autoimmune conditions. If you take all autoimmune conditions in the United States – I know this is true for the United States, and I am sure it applies loosely to other Westernized countries – and you classify them, they are more common than cancer, and almost as common as heart disease. So, it’s probably between the first and second leading disease-type in this country. So it’s certainly a very common issue. And some common autoimmune conditions would be Hashimoto’s hypothyroid, Grave’s hyperthyroid, rheumatoid arthritis, multiple sclerosis, celiac disease, inflammatory bowel disease, psoriasis, eczema, there has been some speculation that macular degeneration could be autoimmune, there’s been some speculation that various forms of heart disease could be autoimmune.

MM: Yeah.

DR: I mean, the list is long. Alopecia, as you already mentioned…hair loss. So, it’s certainly a big deal, and we are starting to learn that, to paraphrase, by making our environment so clean, we are missing exposure to a lot of the bugs and other bacteria and viruses and other microbes that may have had a really important impact on shaping and balances and toning our immune system.

MM: That’s right, yeah.

Autoimmune epidemic

DR: So, I think you’ve done a pretty good job of outlining the issue. And I know you have hundreds of pages about this in detail, but do you have a short narrative on what this issue has looked like over time? Maybe there are some key diseases or exposures that you can summerize for people to give them an orientation of what this looks like a little more specifically.

MM: Of what the epidemic looks like?

DR: Yeah, yeah. Are there any key microbes that have gone missing…

MM: Right.

DR: …correlated with allergies or anything like that?
MM: Yeah, well there are two types of organisms that we are talking about. You know, let me just add something to what you just said – what people don’t realize about autoimmune disease in particular is that it mostly strikes women. The imbalance is like 75 percent women who have autoimmune disease. And no one really knows why that’s the case. One possibility is that men have, obviously, more testosterone, and testosterone is natural immune suppressant.

DR: Sure.

MM: I feel like it’s important to note that, and it always gets overlooked, because these disorders interfere with pregnancy. The very population that is affected is the one that bears children, you know, that carries children. So, anyway…

DR: Sure. It has strong implications for future generations. Absolutely. That is a nice chance to hang a hook, which I want to come back to in a little bit – the area where we have the most potential to fix or help turn around is actually with mothers and with young children.

MM: Yeah, that’s right.

Hygiene and modern medicine is not always bad

DR: So, I definitely want to come back to that in a minute. So, I’ll just recapitulate this briefly and then there’s a quick note I want to make as we launch into some details. I guess you did a pretty good job of encapsulating the issue, which is as we’ve gone from hunter/gatherers to modern day, we are very clean and sanitary, and we are missing exposure to a lot of microbes that help tone our immune system. There is one not you make in your book that I want to echo, because I think it’s important to keep in mind because sometimes when people first learn about this, the pendulum swings the other way, and they want to drink sewage almost…

MM: Yeah.

DR: It’s like, any kind of exposure would be good. But there is kind of this trade off – as we moved from hunter/gatherer bands to highly densely populated cities, that changes the rules a little bit. In a hunter/gatherer band, you couldn’t really have a pathogenic bacteria, because if you killed off the entire hunter/gatherer band, you probably weren’t going to have exposure to other people to spread.

MM: Yeah.

DR: So, you have to symbiotic in a hunter/gatherer context – you can be more pathogenic or more deadly or more lethal in a large population, because if you kill the host, you can easily hitch a ride or go to the next guy because he is so closely located. So, that’s an important thing to keep in mind. Even though a lot of people listening to this are ancestral-minded, as am I, it doesn’t mean we are able to replicated all of those things in many of the cities in the United States.

The other important point is with the increased hygiene in western societies, there has been a lot of good, right? Infant mortality is probably the most well-documented. So, some people are probably aware of that, but I just want to quickly echo that to help keep us grounded, and not let the pendulum swing too far in the other direction.

MM: I will second that in the following way: which is that there is nothing that indicates that any of the diseases that we vaccinate against – I should qualify that – almost any of the diseases that we vaccinate against are at all good for us. So, the point is, you can still get the longevity and survival benefits associated with vaccines and possibly rebuild your microbiota or reintroduce organisms. We are talking about different organisms. The ones that we vaccinate against are precisely the ones you just mentioned, which are crowd diseases like polio, smallpox – these are organisms that have jumped rather recently to the human body from animals, and have not really adapted in mutualistic way to the human body. They are just basically…they just kill you. If you are lucky enough to survive, great. But they kill huge numbers of the people that they infect.

So, the organisms that we are interested in are the organisms that were with us before the crowd disease came. And like measles is possibly just like 200 years old. It comes from a virus, possibly, that lives in cows – rinderpest. Smallpox is maybe from a virus that lives in camels or something like that…within recent times.

DR: Right.

MM: With regard to sanitation, the idea is exactly not to go drink sewage, not to backtrack in that respect. The idea is to use modern science to identify those organisms that are important that we were exchanging naturally that are good for us.

DR: Precisely.

MM: Where it gets, you know, that don’t have a cost. If there are organisms that have a cost and a benefit, the idea is to intelligently understand what the cost and the benefit is.

DR: Emphasis on ‘intelligently’.


MM: The bad response is to say ‘No’ to vaccines. We have to say yes to vaccines, in my view, and to decide we are all just going to drink sewage and eat poo because that’s what we do when one-in-four kids died before age one. No, that’s not right. What we need to do is use 21st Century science to understand what we got rid of accidentally, figure out how to reintroduce in a safe way without tinkering cost. Where this gets interesting, though, is with regards to multicellular parasites, also known as worms.

There is no doubt in my mind that worms can incur some cost – I mean, there are huge campaigns, pretty well-supported by scientific evidence that when you de-worm kids in the developing world, you get an increase in growth, improvement in cognitive ability, these sorts of things. These are not inconsequential. There are those who argue that parasites, which infect somewhere between a sixth and a third of humanity at this point, keep people in cycles of poverty, keep entire countries in cycles of poverty. It was certainly the case in the United States about 100-odd years ago. Poor people were just being absolutely being drained by hookworms.

DR: You make a really good point there, which I remember back to my training in infectious disease. One of the things that struck me was parasite load tended to inversely correlate community output; meaning, the more a community was burdened by worm infections, specifically, the less they could achieve in a workday. They actually needed more people to be able to run the community. There is always a tradeoff in biology. I really agree with what you are saying there. So, well said, absolutely.

MM: Regarding parasites, there is this argument, and it’s well-supported by animal studies – the human trials have yet to prove that it works. So parasites, they persist in the body. They use this older technique for their own survival and procreation, which is that you establish a chronic infection. In order to establish a chronic infection – that is not like the common cold, which makes you horribly sick and then leaves, because you fight it off – they have to subvert your immune system. You end up in this sort of – I like to think of it in Cold War state, where you are very lightly fighting against the parasite, (while the) parasite is pushing back against you. Your immune system, if you have parasites, works slightly differently. Now, what’s interesting about this is that no one is really sure why this is the case. Is the parasite suppressing your immune system for its own interest, or are you, because you know it’s a parasite, holding back. There are these really interesting studies where they in animals enable a total, all-out response against parasites, and they will clear the parasite, but they also cause all of this collateral damage…

DR: Sure

MM: …that is horrific to the organism itself. So, part of what happens at a parasite infection may be that you are protecting yourself against your own potential collateral damage of an overblown immune response. The reality is, you can carry on with a small parasite, with a moderate parasite. You can procreate and eat and do what you need to do as an organism. The best survival strategy for parasites it seems may be simply to tolerate them.

Now, you flip that around and other millions of years of evolution, and maybe our immune system learns to tolerate by exposure to parasites. Tolerate means you don’t overreact. The problem with the modern immune system is that we are constantly overreacting to everything. It may be because we’ve lost exposure to this agent that trained our immune system. It doesn’t mean that parasites aren’t taking something from you; they are. I can tell you from personal experience we are. Depending on the species, they are either eating you – if it’s a hookworm, where they suck your blood and sort of dissolve your tissue and eat you – or they are eating the food that would otherwise be going to you. So they are still parasitic. They are not completely….you know, if you imagine this gradient of relationships, there are the absolute mutualists on one extreme – which is two organisms in a relationship where they are both mutually beneficial; we have a lot of microbes like that.

Then, on the other extreme, there is the opposite of that, which is mutually assured destruction – the relationship of these cow diseases, frankly, where they just throw you, and you eventually get a hold of them and chase them out of your body, if you survive.

Then, in the middle are the parasites. They aren’t exactly, completely…

DR: Benign?

MM: They aren’t benign and they are not completely pathogenic. They are somewhat pathogenic, but they aren’t going to kill you on the spot. They are a cause of morbidity, which is not the same as mortality – I’m sure they could kill you as well. Technically, if your body needs them to function properly, to be trained properly, that sort of enters into the realm of a mutualistic relationship. I’m sort of recapitulating how the thinking on parasites has evolved other the late 20th Century, where parasitologists – people who are studying how bad these things are – eventually arrived to this conclusion. They were like, ‘Wait a minute. If you need it, that means mutualist. The co-evolution has been so tight that something more complicated than just a pathogenic relationship has emerged.

DR: Right.

MM: So, long story short, people are thinking about this now. Maybe we need parasites for the immune system to train. How do we do that? The animal model supports the idea very strongly. Observational studies of people support it. And then if you go to a parasitised population in the rural developing world, they are less likely to have allergic disease. Deworming studies, where you deworm a population, you see an immediate increase, not only in allergic propensity, but there was one study in Africa where they saw self-directed antibodies, anti-nuclear antibodies, which are, in the developed world, indicative of lupus. They aren’t not necessarily indicative of disease. They increase post-deworming, which is really interesting.

So you see this immediate shift of the immune response toward something that you could imagine if you let it go, would produce an allergic or even autoimmune disease.

DR: Right.

MM: And then, of course, there are these cross-sectional studies within, like, one city in Africa – they will look at socio-economic class; there will be less parasites in richer, and more in poor, and they will see, basically, the inverse of the pattern of allergic reactivity. So, the more parasites the kids have, the less likely they are to wheeze and have hay fever. The richer they are, the more likely they are. So, there’s is really good evidence supporting this.

DR: Moises, I just want to interrupt you for one second, because there is a great lead in there. I want to echo something you said a moment ago, and then there is a clinical connection I want to try for us to make. You mentioned a moment ago that we can find this balance between maybe using some vaccines, maybe using some antibiotics. But also, for more pathogenic microbes, preserve exposure to the good microbes – kind of trying to find that balance. There was a group that went to I believe it was Papua New Guinea. They observed the microbiota in these native people who were living in a hunter/gatherer-type band, but were also being given antibiotics when needed by local doctors. They found that these people had…they still maintained a very level of robust diversity, but they had lower infant mortality rates. I think that’s maybe important for me to just echo briefly, that we can still use antibiotics to kill pathogens. That doesn’t mean you are going to totally decimate your microbiota, if you still have good environmental exposure. So, there is a little bit of cause/benefit ratio there, and a trade-off that we can weigh.

Reconciling good vs. bad exposures

DR: The other thing, and this is an important concept – we look at people in Third World countries, like you said. And they have more worms, they have less allergy. Some studies have shown inoculation with worms have helped with some autoimmune-type conditions. So, I think a question that people often are faced with is, ‘What do I do? I’ve read that h. Pylori is protective for some. I’ve also read that it can cause disease. I’ve read the Epstein Barr virus can cause problems, but I’ve also read that it can protect. I’ve heard that warms can help; I’ve also heard that worms can harm you.’ So, trying to reconcile how all this fits together.

I like to look at this through three windows. And I’d be curious to get your take on this. It think the timing of exposure is very important; I think the context of exposure, meaning do you have a highly diverse microbial exposure already, or do you have a very limited microbial exposure already? And then host genetics.

Clinically, when someone comes back with h. Pylori, for example, I examine h. Pylori in the context of timing, context, genetics, and also, of course, clinical presentation, to decide what the best action would or could be. What’s your take on how we reconcile some of these disparities?

MM: I agree with you. I think that for h. Pylori, if you have not been exposed to it early in life, it’s not going to benefit you. And if your doctor tells you to get rid of it, you should. Because the other possible consequence of h. Pylori is stomach cancer or ulcers, neither of which are good. Stomach cancer is extremely aggressive and not very nice to have. For a lot of these exposures, the time to get them, as you said, was early in life. If you don’t have h. Pylori, and you are like, ‘You know what? I read this book. It’s great. I’m going to go get h. Pylori.’ (That’s a) bad, bad idea. It’s not going to help you, and it’s most likely going to hurt you.

Parasites are a little bit different because they are multicellular, perhaps, and because of the kind of immune response they elicit is a modified allergic-type response.

DR: Sure.

MM: The idea is that, by shifting it away from an autoimmune response to an allergic-type response, it can actually halt ongoing autoimmune processes. The fact of the matter is, though, the two studies that have shown this in people for inflammatory bowel disease, this was an agent called TSO, trichuris suis – it’s a parasite native to pigs, it doesn’t reach full maturity in humans; therefore, humans cannot spread it among each other. This is a new kind of medicine, a probiotic medicine. It’s a medicine that in theory could be contagious once you release it, right? This particular agent, TSO, deals with that concern by having a parasite that can’t fully mature in humans. They tested it – it had these, like, amazing results in Crohn’s , and pretty good results in ulcerative colitis. A few years ago, a company decided to try to bring it to market – I should interject that a German company began manufacturing it, and achieved GMP, which is a good manufacturing process from the FDA, which means it is fit for human consumption. It’s not proven to treat anything yet. These guys, Coronado Bioscience, tried to bring it to market. Their trials have been a total, utter failure. They haven’t published their data yet, so no one knows what is going on. Complete failure, though.

DR: Right.

MM: So, this highlights the importance of placebo-control large trials before you assume something works.

DR: I couldn’t agree with that more. I’m a big stickler on that. Yeah, absolutely.

MM: Maybe it was too much to hope for, honestly. Because, if you really understand what this idea says, it says that growing up parasitized is going to prevent the emergence of these diseases. It doesn’t necessarily say that, if you have inflammatory bowel disease, take these parasites and throw them at the disease and have your disease go into remission. That was the idea of this scientist’s research….

DR: That same line of thinking I see a lot with many microbiotal studies, and I’m sure my listeners are sick of hearing me say this, but we see a lot of the microbiotal research showing the same thing, where we see associations with certain bacterial phylotypes and correlations with different diseases. But that does not mean that we A. have the capable to modulate those, or B. even if we do modulate those, (that) we are going to produce the desired health effect.

MM: That’s right.

DR: Just like you said, you have to really do an interventional trial in humans to be able to substantiate that.

MM: Yeah. But I do think that we haven’t seen the end of the story with parasites, is my suspicion. There are various allegations going around about how they messed up the trial, possibly. I’m not really sure that they are that careless. But, the thing about parasites is that they are basically secreting a drug. So you can take a prednisone and treat your autoimmune disease, right? So, parasites excrete actively immune-suppressant drugs. One line of thinking is that we are just going to get the drug and we are going to isolate the molecule and just create drugs out of it. And that will we will deal with it; how we leverage this new understanding. We have new kind of drugs from our old enemies. That’s possible.

It may yet be possible that we can, as one scientist, William Parker, likes to say: Domesticate parasites.

DR: I like that.

MM: The analogy I like to use is of a wolf and a lapdog – dogs are basically genetically wolves, but they look completely different. They aren’t near as wild…

DR: We did that. Humans are responsible for, as I understand it, selection of the wolves that were the most friendly.

MM: That’s right.

DR: As I understand it, it came back to hormonal differences. So, we eventually selected for the friendliest wolves, and now we have lapdogs.

MM: That’s right. What’s funny actually is that some people think wolves domesticated themselves; the most friendly wolves moved closer and closer to people over the time. However it happened, it happened. So it’s possible. The idea is what if we could create a parasite that did not bite, so to speak, but gave you what a Chihuahua gives you. Chihuahua, I guess, give you love. A parasite that just gave you the immune tweaking capacity that you really need and want without any of the damage.

DR: Exactly. I think it’s an exciting area of research, but as you are saying, and I absolutely agree with you, we still have lots to learn before we are really able to clinically apply this stuff in a successful way. It’s really important for people to understand that, because what we see in observational studies, or cell-culture studies, or animal studies can be super interesting. But, there is a large chasm we have to cross between there and actually being able to do that in human, and have a positive health effect.

Strategies to boost immunity

DR: With that as a transition, let’s talk about what we can do to try to increase our microbial diversity or our microbiotal diversity in attempts to make our immune systems healthier. I think mom and children are poised to have the greatest impact. I know you mentioned a number of studies in your book, as well as I’ve reviewed a number of studies with some of my listeners. When we look at moms who live on farms compared to moms who don’t live on farms, the more exposure mom has – in fact, for every additional animal, as found in one study, mom has exposure to, increased the immune benefit it appears to be for the child that is developing inside of her at the time. And even during breastfeeding.

MM: Yeah.

DR: So, the more exposure mom has, the more that – probably because of the bugs and the microbes that she is exposed to – helps to tune the immune system. And that gets passed down to the children. So, how about that as a jump off point, Moises.

MM: Yes. There are caveats there as well. I’m not even sure I put these in the book, because I might not have been aware at the time. There are studies that show that intermittent exposure for both moms and young kids to farm environment – meaning let’s say you go on the weekend to the cow shed – actually have the opposite effect of the one we are after.

DR: Ah, thank you for that, because I had been looking for if that will work. My thinking up until now is, if you can’t live on a farm, try to go there every other weekend, or something like that. But, there is no data, at least that I was aware of. So, please tell us more about that. If you could email me a reference at some point, I’d love to include that in the notes for this call.

MM: These observational studies are tricky, but the thinking is – because you don’t know if what you are observing what you are observing – your immune system is getting a kind of immuno-therapy when you are on the farm. What’s important, in terms of preventing diseases, is that it’s chronic. If you just get it one day or two days, your body treats it like it’s being challenged by an infectious agent. There is a certain amount of…it’s an inflammatory stimulus.

DR: Sure.

MM: When your body can handle a chronic, inflammatory stimulus, it says, ‘Oh, you know I don’t need to react to this.’ It’s in that understanding of not needing to react that you get the prevention of all these disease – you know, the preprogramming of the unborn child, so to speak. If it seems like you are actually getting assaulted for a weekend, you might get the opposite effect – which is that it’s an adjuvant effect. That’s one way of explaining it.

And also in the developing world – I’ll give you the phenomenon and then the possible explanation. Exposure to livestock in the developing world has not always consistently been associated with protection from allergy; in some cases, (exposure) is associated with more allergies. There are two possible explanations: 1. you’re exposed to animal parasites, which do not have…if the parasite is not native to humans, it doesn’t have the modulating effect of preventing; it probably has the opposite effect, which is it serves as an adjuvant.

DR: Right.

MM: It provokes immune response. That’s one possible explanation. The other is that people in the developing world are already so saturated with microbial exposures that more (exposure) has paradoxical effect of increasing nur allergic risk. No one really knows. Also, these studies are done in urban environments, so it’s like cows in the city, in rooms. It’s not the same thing as rural Germany. It’s not the same microbial exposure. So, no one really knows.

What they do know is that in places in the developed world, if you live or grow up on a farm, like in Germany or Denmark or Scandinavia, it seems to have this pretty impressive affect of preventing allergies. There is a whole suite of genes that are expressed in these kids differently from birth that they can see. When you take the core blood and look at it, that seems to indicate that their genes are just playing a different song. They are stimulated in a different way. That song is protective against allergic disease.

DR: Interesting. You make a great note that we always have to be careful with the recommendations we make until we’ve put them through a clinical trial. So, what do you think the things people can do…what do we have the best evidence to support? What do you think we can reasonably say, ‘Hey, here are some things to try to increase your microbial exposure, increase the health of your immune system.

MM: Well, I think diet is basically the safest one. We know what is good for us, pretty much – sort of a Mediterranean-type diet. If you have issues with wheat, clearly you need to avoid wheat. I don’t see any reason, though, if you don’t have issues with wheat, you probably don’t need to avoid it. Whole grains, real food, no junk food, omega 3s, and lots of phytonutrients. There are a number of studies that show observationally that kind of diet of mothers who are pregnant, their kids have a lower risk of asthma, for example.

There are enough animal studies now that show that just have soluble fiber – which are plant sugars that are not digestible to you, that your microbes break down – are incredibly important, is this emerging theme for maintaining the diversity of your microbiota and the structure of your microbiota, so that your microbiota doesn’t become pathogenic to you. When you eat junk food – let’s say I have a nice McDonald’s Happy Meal in the morning, there are these immediate effects that have to do with the microbiota. There is this systemic inflammation that happens, and stuff starts leaking from the gut into circulation, like microbial detritus. It’s like a very, very minor form of sepsis in a weird way.

So the idea is that, chronically, ends up causing all sorts of havoc – from Type 2 diabetes, obesity, and eventually dementia and heart disease. That’s basically the interaction between your diet and your microbes. For me, one of the major proofs that’s important is that if you give a mouse that has no microbes junk food, it’s fine. It doesn’t gain weight – I mean, eventually it will gain weight, but compared to a mouse with microbes, it basically maintains its health for much longer period of time. So, somehow the microbes are very important. What you can do is avoid that. That will increase some diversity. Get a dog is another safe one, it seems to be (1).

DR: I was going to ask about the dog and the sibling effect. If you are going to have a family, maybe plan to have more than one. Would you also say the sibling effect is something that is a fairly safe bet?

MM: Sure, but you shouldn’t have more than one kid just because of that.


DR: Yeah, it’s kind of a big commitment. I’m trying to give people anything to…

MM: Daycare is the other one that’s interesting.

DR: Daycare. And what are your thoughts on in Asia and others studying what is called Forest Therapy? They are taking two groups of subjects. Half have taken 15-30 minutes for a leisurely walk through the city. The other half get that same amount of time for a walk in the forest. They’ve shown decreased scores of depression and anxiety, and increased energy and vigor scores. And other studies where I’d be interested to get your take on – people whom live in ‘Blue Zones’ of ‘Green Zones’ in oceanic or forest environments tend to have lower overall chance of death in lower diseases like depression and cardiovascular disease. It’s been theorized that’s because of the increased microbial exposure we get from those environments. Maybe going to the farm might be a little too much if you are only doing it intermittently. What are your thoughts on forest or ocean therapy.

MM: I think that anything that is going to make me feel good is going to help. But I don’t think that has to be mediated by the microbiome at all. I think a more likely explanation is all sorts of other things. Like, just relaxing. Chronic stress is one way to inflame you. That’s ignoring the microbiome. It’s just like the chronic signaling of stress hormones of cortisol. Eventually it wreaks havoc on your immune system. That is going to mess up your microbiome. And then there will be some sort of feedback, potentially.

There is this tendency these days to say everything must be mediated by our microbiome.

DR: Totally, totally agree.

MM: I don’t think it’s always true. There is still the other stuff, the other 150 years of science still holds.

DR: Right, so just basic concepts of stress reduction…

MM: Yeah.

DR: Time off, not thinking, maybe being with friends. And Chris Kresser and I recorded a podcast about this recently; about the importance of having hobbies, friends, time with…

MM: Yeah, I totally agree with that.

DR: But there is one other Devil’s Advocate, or other side of the coin, I’d like to echo: there have been some studies – because do look at this in a very skeptical way, and try not to just frame things via the microbiota just because it’s en vogue – but there is one study, for example, when children grew up in houses with a higher amount of naturally growing plants around their house, they had increased microbial diversity on their skin, and that correlated with decreased atopic skin conditions and asthma. So, I think there is a microbial angle to it. But also, to your point, we don’t have to force everything…you know, we shouldn’t say the only reason to go to the woods is for the microbiota.

Episode wrap-up

DR: All right, my friend. I know you have another call that I know you’ve got to prep for, so I will let you go here. But, before I do, anywhere you’d like to make people aware where they can track you down. And, (is) there anything you’d like to make our listeners aware of?

MM: My site is Moisesvm.com, for whatever you want to checkout there. I think the one thing we didn’t get into is that I feel like is one of the more important takeaways of my book – sort of like a piece of mind takeaway. My book being a reflection of a whole bunch of research. There are these genetic propensities underlying autoimmune and allergic diseases. I think what’s important to understand is that those propensities – they are like a variation of our immune system, on the genes of the immune system – they exist because they served a purpose in the past. That purpose was likely keeping us alive as we faced this universe – that is hard to imagine now living the way we do – of infectious diseases that killed us, are what shaped our lives. What killed our kids. So basically, if you have some autoimmune disease right now, there is nothing wrong with you. What it is is that the world has changed such that your genes are no longer protecting you – they are spiraling out of control. But that underlying genetic architecture is a very good reason for its existence. It got you this far. There is nothing wrong with you. We just need to figure out how to give it what it expects to prevent the emergence of these diseases.

DR: I agree with you 100 percent. I think the more we learn about medicine, the best paths to healing are just putting someone, or trying to make the environment that someone is in, the best for their overall health. We can’t change your genes. And some of these super meticulous that we try to manipulate in the body doesn’t always pan out. By figuring out what the best environment for you is, and keeping you in that environment, I think that tends to always be a really safe bet.

MM: Yeah, and those genes exist for a reason. Genes are not always random. I mean, there are spontaneous mutations, but…

DR: So maybe give yourself a pat on the back because some of these autoimmune genes – if we all got lost in the woods for three months, you might live and we might…and with people with no autoimmune conditions might die because they don’t have a strong enough immune system.

MM: That’s right.

DR: So, yeah, a little bit of self-love to wrap up the call. Well, cool. Thank you so much for coming on. I really appreciate it. I am sure everyone got a lot out of it. Check out the book, guys. It was an amazing book. And hopefully we will have you on the show again soon; maybe when some new stuff is coming down the pike on your end.

MM: Sounds good.

DR: Thanks again. Take care.

MM: Thanks a lot.

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