From LET’S LIVE

Magazine By David Steenblock, D.O.

March 1982

The Brain Therapeutics Medical Clinic Personalized Regenerative Medicine David A. Steenblock M.S., D.O., H.MD 26381 Crown Valley Parkway, Ste. 130, Mission Viejo, CA 92691

Systemic Lupus Erythematosus

WOULD YOU BELIEVE that the big, bad wolf is still inpursuit of grown up Red RidingHoods? Lupus comes from the Latin“fox wolf”, whileerythematosus means “red”.This red wolf primarily attackswomen between the ages of 20and 40, but may occur betweenchildhood and old age in bothsexes. The name is derivedfrom the characteristic red facerash and the skin changes,which may resemble the bite of a wolf. The disease can produce anumber of problems for thevictim, including fever,arthritis, anemia, kidneydysfunction, and heart, lung,nerve and gastrointestinalinflammations. The diseasecomes and goes and the personmay be totally healthy for years and then have a return of theproblem. The severity rangesfrom a very mild illness withlittle effect on the person to anacute, severe disease afflictingmany organs simultaneously. The disease seems to beactivated by infections,sunlight, surgery, pregnancy,physical or emotional stressesand certain drugs. Treatment for lupus hasvaried somewhat over the yearsbut most authorities nowrecommend bed rest for dayswhen the disease is active, the

Fighting The Big Red Wolf Of Diseases Naturally

use of aspirin, and in severecases – cortisone. The immune system is thekey to understanding thecause(s) of lupus. Theimmune system includes thosecells of your body involvedwith attacking bacteria,viruses, foreign proteins (e.g.,ragweed), and cancer. Thereare three main types of“immune cells” and allcirculate in the blood and bodyfluids. These include the B-lymphocytes, the T-lymphocytes, and themacrophages. The B-lymphocyte is a bonemarrow derived cell and isresponsible for the productionof antibodies. Antibodies arespecific proteins produced bythese cells to fight off foreigninvaders. If for any reasonthese B-cells become moreexcited than they should be,they will produce moreantibodies than normal; anddiseases such as lupus,allergies, rheumatoid arthritis,scleroderma, etc., may occursince all of these diseases havethe common property ofhaving too many antibodiespresent! At times of stress,injury, infection, sunburn, andpossibly menstruation, theblood will contain injured andfreshly killed antibody cellsdue to any of these harmfulfactors. If at the same time the

B-cell is “hyper” and ready tomake antibodies in greatquantities, there is a goodpossibility that the B-cell willbegin to make antibodiesagainst some of those injuredor dead body cells. If thathappens, the beginning of anautoimmune disease is in themaking! Auto refers to “self”and the disease is thus animmune attack directed againstyour own normal body cells. The T-lymphocytes are ofgreat importance to all of ussince they protect the bodyfrom viruses and help with thebody’s surveillance againstcancer. Besides thoseimportant functions they helpregulate the B-cells. A certaintype of T-cell called asuppressor cell appears to notbe functioning well in lupus.The suppressor cell’s job is tosuppress the activity of the B-cell. If the suppressor cells arenot functioning correctly, theywill not suppress the B-cells,which in turn will tend tobegin to make too manyantibodies. Macrophages are anothertype of cell that is involvedwith immune regulation. Themacrophage is a phagocyticcell (phago = to get, cyte =cell) and is responsible forpicking up foreign proteinsthat enter into the body anddelivering these to the B and

Things You Can Do Right Now:

Increase Sulfur-containing amino acids: cysteine and methionine RAST & Cytotoxic Tests Avoid Caffeine Avoid Alcohol Tryptophan-poor diet Thera-Comp Diet Evening Primrose Oil Vitamin C Vitamin A Biotin, B1, B5, B6, Niacin Zinc L-Glutamine

childbearing years a womanhas to take care of herchildren, husband, the house,the checkbook, the groceries,and the babysitters whileworking at her own job,menstruating monthly, andalways being rushed.Combine all these with theoverwhelming feeling ofbeing on a treadmill forwhich you receive littlereward (lack of jobsatisfaction) and you have aperson who is undertremendous stress. Add avirus, injury, sunburn, poordiet, surgery, pregnancy,lack of sleep, poor lifehabits, etc., and the “springwill have been wound tootight” causing disease toappear. Is it any wonder thatthe main treatment for lupusis rest? Excessive stress activatesthe adrenal glands toproduce adrenaline andcortisone. Cortisone has aninhibitory effect onsuppressor T-cells whileadrenaline activates the B-cells to make moreantibodies. Stress also causes a decreasein serum zinc as doesestrogen and pregnancy.The white spots seen in thefingernails of people undergreat stress are indicative ofthis deficiency. Zincdeficiency causes a loss oflymphocyte function andespecially of the of thethymus gland cells and theT-lymphocytes.5 This lack ofzinc may be one of thereasons why women are somuch more susceptible tolupus than men. Addition ofzinc to the diet increases thesize of the thymus,6

improves the immunesystem, and facilitates theformation of prostaglandinE-1 from the essential fattyacids. 7

T-cells. All three types of cells (B,T and macrophages) work together in mustering thecorrect attack against whateverforeign invader is present. Theheadquarters for theirinteraction and planning of thebody’s attack is the thymusgland, which is a gland that ispresent in the neck close to thethyroid. It appears that for correctfunction and balance of theimmune system, the thymusgland has to work correctly.The thymus gland is large inthe child, reaches its peak atthe time of puberty andgradually diminishes in sizeand function as we get older. In lupus the thymus gland hasbeen shown to be abnormal inappearance1 and have a premature loss of thymushormones.2 These deficiencies ofthymus function are veryimportant since if the thymusgland doesn’t work properly,the suppressor T-cells will not work properly and hyper-reactivity of B-cells will result, setting the stage for thedevelopment of lupus. Dr. Jerry Daniels and hiscolleagues at the University ofTexas Medical Branch inGalveston have given thymushormone to patients with systemic lupus and have foundevidence that it will correctcertain immune imbalances.They are currently doing arandomized study to see ifthymus hormone will help.Since the disease tends to runin families, a genetic tendencymay be responsible for many of the thymus glandabnormalities, however thethymus gland also can beinjured by a number of things.In childhood, if not enoughprotein or calories are presentthe thymus gland will notdevelop properly. Lack ofvitamins, minerals,

essential fatty acids in agrowing child can injure theimmune system’s regulatingability – possibly for life. Beside having adequatelevels of protein and caloriesin the diet it has been shownthat vitamin B-5, B-6, and B-12, vitamin C, zinc, biotin,iron, selenium, essential fattyacids, vitamin A and folicacid3 are essential for properimmune system development.Vitamin B-6 deficiency, forexample, causes decreasedthymus hormone while avitamin A deficiency decreasesthe actual number of T-cells inthe blood. During an activeflare of the disease the numberof circulating T-cells isdiminished in the blood whilethe number of auto-antibodiesis increased. Since anythingwhich will diminish theactivity of T-suppressor cellswill lead to hyper-reactivity ofthe B-cells the importance ofadequate vitamin A and othernutrients in optimizingimmune regulation is clear. The main essential fatty acidin food is linoleic acid and thisis present primarily invegetable oils. Once takeninto the body linoleic acid isconverted into gamma-linolenic acid and then intoprostaglandin E-1.Prostaglandin E-1 (PGE-1) hasmany beneficial attributes anda deficiency of this has beenlinked with a great variety ofillnesses. The highestconcentration of PGE-1 in thebody is found in the thymus!PGE-1 has an effect verysimilar to thymus hormone inproducing growth anddevelopment of T-cells. Adeficiency of PGE-1 occurswith dietary lack of vegetableoil or when a certain enzyme(delta-6-desaturase) is notworking in the body, whichnormally converts linoleic acidinto PGE-1. Hydrogenation of

vegetable fats (as in somemargarines) converts a portionof cis-linoleic acid into trans-linoleic acid, which cannot beused by the body to makePGE-1. Saturated fats,cholesterol, and sugar willinhibit the function of thedelta-6-desaturase enzyme andlead to deficiencies of PGE-1.Deficiencies of vitamin B-6,vitamin C, zinc, magnesiumand niacin have all been shownto impair the enzyme andresult in decreased tissuelevels of PGE-1. In 1982 there were no

studies on PGE-1 levels inlupus, but many studies havebeen conducted since then. Inone 1995 study, rats treatedwith the antiinflammatoryprostaglandins (PGE-1) had aprolonged survival rate andamelioration of kidneydisease4 associated with lupus,suggesting that there is,indeed, a deficiency of thesebeneficial prostaglandins inlupus sufferers. A relateddisease (scleroderma) has beentreated with some success bygiving evening primrose oilorally. This oil has a highconcentration of gamma-linoleic acid and will increasethe body’s levels of PGE-1since it can sidestep theblocked delta-6-desaturaseenzyme. Most people with lupus tend

to be women (nine to one) andmore depressed and anxiousthan people with other types ofchronic illnesses. Women aremost often afflicted with theproblem in their childbearingyears (20 to 40), and these arethe years of greatest stress.Society’s and her ownexpectations of herself are bestexemplified by the saying “Awoman is expected to act likea lady, think like a man, andwork like a dog.” Stress inexcess can precipitate diseasein anyone. During theand

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Stress can produce stomachand intestinal spasms orirritability. This irritability ofthe gastrointestinal tract causesthe release of histamine andserotonin into the circulation. These substances directlyinhibit the function ofsuppressor T cells. Theseobservations would indicatethat treatment of lupus shouldbe directed at least in parttoward inhibition of theproduction of adrenaline,serotonin and histamine sincethat will tend to correct the immune imbalance. Adrenaline is produced byboth adrenal glands and nervetissue in response to somethingperceived as dangerous to you.This produces the well known“fight or flight” bodilyresponses including theliberation of stored sugar (glycogen) from the liver sothat there is enough sugar forthe muscles to use if we needto run fast to get away from theperceived danger. If yousubstitute the word anxiety fordanger here, you can appreciatethat chronic anxieties will keep your adrenaline pumping hourafter hour, day after day. Thisconstant bombardment ofadrenaline on the liver causesthe eventual depletion of theliver’s stored sugar reserves.When the blood sugar starts tofall a few hours after eating,there is little stored sugar in the liver to be put back in thebloodstream. Hypoglycemiasymptoms then begin toappear. Some of the symptomsof hypoglycemia are due to therelease of more adrenalinesince the body perceives thelow blood sugar as anotherstress. This causes even more loss of the liver stores of sugarleading to more and moreproblems. Adrenaline itself has a directstimulating effect on the B-cells and this

Since 40 percent of thenormal population suffersfrom this condition more orless, the likelihood is thatpeople with lupus may wellhave the problem also. If the irritable bowelsyndrome is present certainchanges occur in the bowel.First, the pH graduallychanges from the optimumof six to an undesirableeight or nine. Thesechanges occur because thedecreased peristalsis allowsthe food to putrefy andferment. This allows anovergrowth of harmfulanaerobic bacteria and thesecause the formation ofharmful, toxic, metabolicpoisons to be formed frombile salts, foodstuffs, andthe bacteria themselves.10

These substances decreasethe liver’s ability todetoxify foreign proteinsand other poisonousmaterial. Tryptophan is anessential amino acid, whichis present in dairy products,nuts and bananas. Onceeaten and absorbedtryptophan is converted intoserotonin, and 95 percent ofthe body’s content ofserotonin is contained in thebowel wall. When thebowel contractsspasmodically, thisserotonin can be releasedinto the blood. Serotonin isthought to be inactivated bya liver enzyme system,which also inactivatesadrenaline and relatedcompounds. If the liver hasbeen injured by alcohol,toxic material from thebowel, stress, or has lost itsstores of sugar (glycogen)as in hypoglycemia; thisadrenaline and serotonininactivating enzyme systemwill become overloaded andthe blood concentrations of

stimulation of the B-cells willaggravate allergies and in thecase of lupus will worsen thecondition. Oftentimes a simplechange in diet with avoidanceof all sugars, sweet foods andhigh carbohydrate foods willimprove the allergic state! To counteract the excessesof adrenaline there are anumber of tricks that can beemployed. Raising the intakeof the sulfur-containing aminoacids (Cysteine andmethionine) works byincreasing the detoxificationsystem of the liver. Vitamin B-1 (thiamine) isnormally the fastest vitamin tobe destroyed in the body with a“half life” of 20 minutes.Vitamin B-1 is also used upfaster by the body when thereis increased sugar orcarbohydrates in the diet orwhen there is more stress andadrenaline in the system. Thebody must receive adequatelevels of vitamin B-1 in orderto counteract these increaseddemands to help normalize themetabolism. Vigorous physical activity isalso capable of reducingadrenaline levels and is usuallyquite helpful at reducing stresslevels; but in lupus it is notrecommended unless advisedby your physician. Food allergies can be ofgreat importance in lupus aswell as other chronic diseases.Patients with lupus have indeedbeen shown to have more foodallergies than most people.8Food allergies are difficult todiagnose and there is acontinual controversy overwhat tests to use if any. In myexperience I have found thatthe use of both RAST andcytotoxic tests give the mostaccurate results and help thepatient the most. If only one orthe other is used, often aserious allergy will be missed.This will hamper the healing

process since eating that onefood may well produce atremendous stress on the bodyand worsening of the condition. Caffeine tends to further

stimulate the action ofadrenaline in the body andtherefore should be avoided(coffee, tea, chocolate, sodapop, etc). Alcohol also must be

avoided in all forms since ittends to release adrenaline inthe body and also injures theliver, further worsening theproblem of hypoglycemia. Byinterfering with the liver,spleen, bone marrow andlymph node’s phagocytosisactions, alcohol also allowsforeign proteins to circulatelonger in the body, which tendsto produce more allergies.Alcohol also damages smallblood vessels (venules) andmakes them “leaky” whichallows fluid from the blood toescape into the tissues. Oncein the tissues this “edema”fluid causes the breakdown of atype of cell called a mast cell,which then liberates its storesof histamine. Histamineaggravates all allergies bycausing more leakiness of thesmall blood vessels (giving theclinical symptoms of waterretention, runny nose, wellingof tissues and weeping mucousmembranes) and by inhibitingthe suppressor T-cells. 9

Stress induced adrenalineparalyzes the intestine andinterferes with digestion. Asfood passes into the paralyzedbowel the food will “sit” in oneplace until such time as theamount of food is great enoughto physically irritate the boweland then the bowel willcontract spasmodically. Thiscombination of paralysis andspasm results in the clinicalpicture of constipation,diarrhea, or alternating bouts ofeach, which is called theirritable bowel syndrofurther me.

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serotonin and adrenaline willrise. Injection of adrenalineand serotonin into humanvolunteers causes severelyconstricted skin bloodvessels to the point ofcyanosis.11 Serotonin andadrenaline are both powerfulblood vessel contractors.Elevated levels of serotoninhave been demonstrated inpatients with irritable bowelsyndrome.12

The irritable bowelsyndrome is most often dueto nervous tension or foodallergies both of whichproduce excessive levels ofadrenaline. Thiscombination of elevatedadrenaline and serotoninlevels is probably the reasonpeople will have cold handswhen they suffer fromconstipation. From the above you couldbe led to believe that patientswith lupus have elevatedlevels of serotonin but in factthey have decreased levels!Apparently these peoplehave a decreased ability toconvert tryptophan intoserotonin in the body due tomalfunction of variousenzymes. The mechanismfor this enzyme inhibition isnot clear but a case can bemade for tryptophanmetabolites as a generalizedpoison to the body. Injectionof adrenaline into humanvolunteers causes largeincreases in plasma freetryptophan.12 Stress releasesnonesterified free fatty acidsfrom fat and thesesubstances raise the levels oftryptophan. Lack of propernutrition (proteins-calories-vitamins) also can raiseblood levels of tryptophan. Tryptophan breakdownproducts have carcinogenicproperties13 causingleukemia and tumors inmice. When tryptophan is

exposed to sunlight (UV) inthe presence of oxygen asfound in and around thecapillaries of the skin, anumber of poisonous andcarcinogenic compoundsmay be formed. One of themost serious is hydrogenperoxide. If any of thesecompounds come into closecontact with a cell, that cell’svital structures may bechemically altered to thepoint that the body no longerrecognizes that cell asnormal. These changescould then result in thedevelopment of auto-antibodies. 14

In summary, a person maydevelop lupus from thecomplex interactions ofstress, injury, anxiety,sunlight, diet, genetics,viruses, etc., all of whichraise tryptophan levels eitherdirectly or by inactivation ofthe enzymes that degrade orconvert tryptophan intoserotonin. The excesstryptophan is partially brokendown to form proteindamaging chemicalsespecially in areas of theskin, which are sun exposedand where the circulation isslowed due to blood vesselconstriction. The samefactors of stress, excessadrenaline, poor nutrition,injuries, etc., also create animbalanced immune systemthat is over-reactive in termsof seeking out foreignproteins to destroy.Treatments of lupus shouldtake all of these factors intoaccount. From a dietary point ofview the worse the disease is,the more rigid and strict thediet must be. As the diseaseimproves dietary controls canbegin to be relaxed. In lupusthe use of a diet that isdeficient in tryptophan andrelated compounds is

important as illustrated bythe increased survival ofanimals with lupus on such adiet.15 Removal of saturatedfats, chocolates, cholesterol,dairy products, wheat, nuts,pineapple, bananas, sugar,sweet foods, alcoholicbeverages, caffeine-containing drinks and allfoods one is allergic to is ofgreat importance when thedisease is active. The onlypossible way of followingsuch a diet is with the helpof a computer-selectedrecipe program such asoffered by THERA-COMPP.O. Box 6083, Santa Ana,CA 92706. They areworking on an on-linetherapeutic dietary programthat eliminates foods you areallergic to,or which may aggravatesome physical problems.Thera-Comp will prepare a14-day diet, which excludeswhatever foods you wish toexclude. Thera-Comp thentries to construct your diet so thatnone of the remaining foodsis repeated more than oncein four days. When thisservice is ready, thecomplete diet can be sent toyou by priority mail, or by e-mail. The cost will be$12.95. Taking daily supplements

of evening primrose oil,vitamin E (non-wheatderived), vitamin C,methionine, cysteine,vitamin A, biotin, VitaminB1, B5, B6, niacin and zincwill help correct theunderlying biochemicalabnormalities. L-glutamine may behelpful since it has beenshown recently to have amarked anti-inflammatoryaction comparable tophenylbutazone – a cortisonetype of drug. L-glutamin

antagonizes the effects oftryptophan, serotonin, andhistamine. 16

In severe cases the use ofplasmapheresis is producingbeneficial results by actuallyremoving the excessquantities of antibodies.17

The immune system is thensuppressed with cortisone toprevent further antibodyproduction. Perhaps theaddition of the concepts ofstress reduction, a specificdiet for each person,nutritional supplements andrest will be of additionalbenefit and we can chase thatold red wolf away once andfor all!

REFERENCES

1. Arch. Intern. Med. 124: 60-63, 1969. 2. J. Urol. Nephrol. (Paris) 78:994, 1972. 3. JAMA 245(1): 53-58, 1981. 4. Clin Immunol Immunopathol. 1995 May:75(2):125-30 5. Lancet, 7917, 1973. 6. Lancet, 8047, 1977. 7. Med. Hyp. 7: 1211, 1981. 8. J. Allergy Clin. Immunol. 50: 18-30, 1972. 9. Amer. J. Med. 71: 100-104, 1981. 10. “Colon Cancer, Part 1,” Let’s Live, November 1981, 11-14. 11. Trans. Ass. Amer Physicians 79: 54-63, 1957. 12. Ann. Intern. Med. 59: 164, 1963. 13. Clin. Sci. and Mol. Med. 53: 227-232, 1977. 14. J. Cancer Res. Clin. Oncol, 96: 163-168, 1980. 15. Science 191: 468-469, 1976. 16. Agents and Actions 11, 3: 243-249. 17. Dubois, Lupus Erythematosus, 2nd

Ed., 121. e

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