Thursday, February 18, 2010

Focus on Dr. John Chia, Researcher

The Patient Advocate wants to write about Dr. John Chia. Dr. Chia is an infectious disease specialist who worked on EBV for many years. He got involved in CFS/ME by happenstance. His son Andrew came down with an unknown illness just as Dr. Chia was becoming interested in enteroviruses. Dr. Chia connected the dots, solved his son's illness, and reforged a connection between CFS/ME and enteroviruses.

The Patient Advocate first saw Dr. Chia in Fort Lauderdale in 2007. Subsequently the PA has seen Dr. Chia give lectures at the Invest in ME conferences in London in May of 2008 and 2009 and also in Baltimore at the HHV6 conference in June 2008. The first two lectures can be purchased on DVDs from the Invest in ME group and the Baltimore lecture in on the internet here.

Dr. Chia will give another presentation in London in May 2010.

Dr. Chia believes that enteroviruses are involved in CFS/ME. He takes stomach biopsies from his patients and controls and stains them to identify enteroviruses. These viruses included Coxsackie B (1-6) and 32 different Echoviruses. Dr. Chia finds enteroviral involvement in 82% of his CFS patients and 20% of his controls. The study can be read here.

Dr Chia does not claim originality in this study. Instead he builds on a forgoteen but establish legacy of research in the UK, particularly of John Richardson (d.2003.) Coxsackie and other enterovirus were on the front lines of CFS/ME research until they faded from the picture for a variety of reasons. Such are the ways of science, especially in CFS/ME research. Dr. Chia, with his research, has brought enterovirus back into to picture.

Dr. Chia ultimately identified enteroviral presence through stomach biopsies, which proved that these viruses continue to live in the gut ecology. This flies into the face of the idea that enteroviruses are hit and run viruses.

Dr. Chia discovered an antibody test for Coxsackie and Echoviruses that is more specific than other labs. By serendipity, a sample from Dr. Chia’s office ended up in ARUP lab in Salt Lake City - and the results came back quite positive. Upon investigation, Dr. Chia discovered that this ARUP lab does a test that is more specific than other labs. This ARUP test reports antibody levels of Coxsackie B 1-6 and 5 of the 32 Echoviruses. An elevation of 1:320 (1:32) is considered to be significant., especially for b4. The number of the ARUP tests are:

0060055 Coxsackie antibodies by neutralization
0060053 echo virus antibodies by neutralization

If a patient is unable to get a stomach biopsy, the key is to get an antibodies test at ARUP.

My patient did tests at Focus labs and ARUP at the same time. Here are the results:

October 2009, at Focus Diagnostics
b1 1:16
b2 <1:8
b3 1:16
b4 1:16
b5 1:8
b6 1:8

October 2009, at ARUP labs
b1 <1:10
b2 1:320
b3 1:80
b4 >1:640
b5 1:10
b6 <1:10

Dr. Chia would consider the elevated Coxsackie b2 and b4 from the ARUP lab to be significant. The significance of this is heightened by the fact that the b4 is sustained at 1:640 in seven tests over a four year period.

Is there enteroviral involvement here and what is the treatment?

So far, Dr. Chia has been able to prove the existence of enteroviruses in the gut of his patients. This is a surprise to the CFS/ME community as most people had no clue about this. It took Dr. Chia’s individual thinking and persistence to look in this direction. Dr. Chia is aided in his research by his son and his wife. He introduces his lecture by saying that instead of going out to dinner, he, his wife and his son go to the lab. Dr. Chia speculates that if enteroviruses are in the gut, then they could be in the heart, the thyroid, the pancreas, and the brain. Proving the existence of enterovirus in tissue is a big deal - but it does not establish that it is the cause of the CFS/ME. Further research will perhaps elucidate the involvement.

In the meantime, Dr. Chia assumes that enteroviruses are a cause of CFS/ME in a large proportion of his cases. At the moment the treatments for enteroviruses are limited. Initially Dr .Chia gave a number of patients interferon, but he has stopped doing that because of toxicity problems and relapses after treatment. In the past few years, having stopped interferon treatments, Dr. Chia is using various Chinese medicines. He first used Matrine, which was literally difficult for patients to stomach. More recently he has been giving his patients Oxymatrine. Dr. Chia says that 53% of patients show betterment on Oxymatrine and a slightly higher percentage if they have Coxsackie B2 and B4. He recommends that Oxymatrine be started slowly and titrated up to a dosage level of 4-6 tablets a day. The patient can determine whether the Oxymatrine is effective with three months of treatment. The treatment is stopped if it does not bring betterment in this time period.

Dr. Chia imported the oxymatrine from China but worried about impurities. in the last few months he is making his own in the USA, a formula made conforming to FDA regulations and considered to be safe. There are some suspicious souls who feel that Dr. Chia has invented all this enteroviral CFS in order to sell his own supplements and this, of course, is a fantastic joke. Dr. Chia is one serious scientist and doctor, who strives mightily to bring clarity to a subsection of CFS/ME. It is anyone’s guess how large this subset really is. Cort Johnson’s linchpin site has more information on Oxymartrine here. The HHV6 Foundation has a patient forum with some discussion of Oxymatrine use.

Cort Johnson’s excellent site has two in depth interviews with Dr. Chia here and here.

The strangest aspect to this situation is that Dr. Chia makes uncertain headway in this world of CFS/ME. Somehow in this vague and confusing world of diagnosis and treatment of CFS/ME his ideas are a little to specific and scientifically proven. The world of CFS prefers to clamor towards unproven claims of the magic bullet – XMRV* for instance – putting aside serious research that stares at us right in the face. For instance, Dr. Chia applied for funding from a recognized CFS/ME organization to study the effect of Oxymatrine on CFS/ME patients, but was denied funding.

A noticeable exception to a general level of indifference towards Dr. Chia is his reception in the UK, where he has been invited to give lectures for three years running. It will be worthwhile keeping an eye on his research as Dr. Chia is really onto something and does not seem to want to be interrupted in his headlong effort to solve part of this illness. The unfortunate part of this situation is that with the clear indentfication of a potential cause of CFS/ME no funding is available to develop anti-enterovial drugs. Dr. Chia says it will be ten years before such drugs will be forthcoming. This is a long time to wait.

Dr.Chia is on the board of the Enterovirus Foundation which can be found here.

*This is not to say that XMRV research is not important. It obviously is tremendously important and bears following very closely. However since October 9th, the CFS/ME community has gone haywire over the possibilities of diagnosis and treatment for XMRV. It is ironic, in this environment, that doctors and researchers are not paying more attention to the longstanding enteroviral involvement with CFS/ME. It might be worthwhile to take a step backwards and look once again at the possibility that enterovirus are heavily involved in CFS/ME, with or without XMRV.

Tuesday, February 16, 2010

Gut treatment using the Metametrix GI Effects test

Many doctors, including Peterson, Cheney, Guyer, Myhill and de Meirleir advocate working on the gut and trying to get it into balance. This is not an easy enterprise. De Meirleir says that it takes months to redress the grievances of a dysfunctional gut. This is a slow rebuilding process and it takes time.

Dietary changes have been seen as essential to bringing the gut into line, particularly changes that involve avoidance or elimination. Many items need to be restricted or given up, depending on the specifics of the patient. Often this will involve cutting out white flour, sugar, caffeine, soy, dairy, wheat, tobacco, and alcohol. Adding fresh organic vegetables, low carbohydrates and lean meats along with bottled water is seen as a step in the right direction Many people do not want to constrict themselves in this way and make these substitutions, as they are already giving up so much with this disease. It takes a special type of patient to do this - especially as the results are not immediately or readily apparent.

One of the chief weapons in trying to control and alter the gut is the diagnostic stool analysis (CDSA). In the US, stool tests are done by Metametrix, Genovas, and Diagnostechs. In Europe the chief test is the fecal microbial analysis at RedLabs BE. Each of these tests have their particular advantages, which the reader can explore. Dr. Guyer uses the Metametrix. Dr. Vrchota uses Genovas. Rich van Konynenburg recommends the Diagnostechs. My patient has been using the Metametrix test for the past three years.

The first set of items - Predominant Bacteria (Obligate anaerobes and Facultative anaerobes) – are an important set of markers of the health of the immune system. “They provide colonization resistance against potentially pathogenic organisms, aid in digestion and absorption, produce vitamins and SCFA’s and stimulate the GI immune system.” Dr. Guyer says that these items should be on the right of the graph. If the little dots are to the left, this indicates that the item is low, and that it needs to be raised. Unfortunately, there is nothing that can be directly done to elevate these items or to bring them into a more normal range.

Bacteroides sp. along with Bifidobacteria sp. should be highest. The information about Clostridia sp., Prevotella sp. and Mycoplasma sp. is confusing, to say the least. Prevotella is one of the three bad boys that shows up on de Meirleir’s list, along with Enterococcus and Streptococcus. Prevotella can be lowered by taking oxbile or Creon (suggested by de Meirleir). Oxbile can be supplemented by itself, or as part of a pancreatic enzyme such as GNDL digestive Enzyme.

Two items that are key to good gut ecology are Lactobacillus and Bifidobacter. These two items are often very low in CFS patients. A low number of these two is a good indicator that the bad boys are in control. The patient can attempt to raise these items with Probiotics. There are many Probiotics available on the market. Some are seen as better than others. Treatment has to be personalized, and trial and error comes into play.

VSL #3 is seen as a quite good and well-researched probiotic. It is ordered on the internet. Culturelle, available in grocery stores and pharmacies, is also well researched, and has the advantage of being D-Lactate free. D-Lactate producing Lactobacillus and Bifidobacter probiotics are seen as a problem for CFS patients. Custom Probiotics makes a D-Lactate free combination of Lacto and Bifido. Harry, who runs Custom Probiotics, seems happy to talk about the advantages of his products, which he has designed himself. Mutaflor makes a probiotic that is seen as providing great benefit. This product can be purchased in Germany and shipped to America. De Meirleir and Cheney both use this product. Recently, Dr. Alan Logan on Cort Johnson’s most valuable site, has been promoting Align, a bifidobacterial probiotic. Align has a small amount of sugar in it, and is also D-Lactate free. Dr. Guyer recommends Allergy Research’s Russian Immune for boosting the immune system.

There is continuing research into various probiotics and their relationship to particular illnesses and to health in general. For instance. there is a probiotic in development that supposedly eats oxalates, for those of you that have that particular problem.

So it would be prudent to keep reading about probiotic research and keep in mind that it might also be useful to rotate probiotics.

One recipe for making gut ecology improvement might be this:

GNDL digestive Enzyme
Custom Probiotics, D-lactate free
Culturelle GG
Russian Immune
Symbiotics Colostrum

Opportunistic Bacteria emerge for various reasons: lowered immunity, poor diet, parasites and so forth. Among these bacteria are Klebisella sp. and Citrobacter sp. They are identified and dealt with directly with anti-microbials or herbs.

Pathogenic Bacteria come next and include four items, including helicobacter pylori.

The Yeast/Fungi section will report on Candida. Candida is reported on the intensity of its presence, with various stages being indicated. Candida seems to plague CFS/ME patients. (Some people think candida is a cause of some CFS/ME.) Candida can be dealt with in several ways. The first way is through an anti-Candida, low-glycemic index, hypoglycemic diet. Information on this diet can be found is various places on the internet. Dr. St. Amand’s recommendations are particularly valuable. High candida can also be attacked by prescription drugs Nystatin and Diflucan - but the treatments often need to be repeated. Diet needs to be dealt with in a stringent fashion, and probiotics used to increase the proportion of good bacteria.

The Metametrix test identifies parasites in the gut. These can range from Hookworm and pinworms to a host of other parasites. Specific identification allows for specific treatments. Some of the most common parasites are listed in the Metametrix interpretative guide.

Adiposity index elevation is associated increased caloric extraction from food, whatever that means.

Beneficial SCFA (short chain fatty acids) are seen as wanting to be up in the normal range. “Production of SCFA in the intestinal lumen plays an important role in the maintenance of the intestinal barrier.” Low total SCFA and low n-Butyrate are seen as not being good. “Presence of short chain fatty acids and n-butyrate are essential for the health of the colon. In general, high normal levels of these could mean that there is an optimal fiber intake and a balanced bacterial population.”
These items are signs of intestinal health if they are present in the mid to upper normal range. Butyrate can be supplemented.

Propionate invites further questions for CFS/ME patients. Dr. Alan Logan wrote this: “Writing in the journal Physiology and Behavior (2004), these researchers showed that intestinal lactic acid, both L-lactate and D-lactate, as well as another potentially brain toxic fermentation product called propionate, were all involved in the behavioral disturbances.” So the picture with propionate is confusing.

Lactoferrin is a marker for gut inflammation and need to be treated if present.

Under Immunology, Fecal sigA is low - due to stress or high - resulting from immune response. Anti-gliaden sigA elevation is associated with gluten sensitivity.

Additional tests are self-descriptive and include ph, which seems to want neither to be too low or too high.

Digestion includes Elastase 1, which should be over 500. Low elastase 1 is associated with pancreatic insufficiency. High Triglycerides indicate malabsorption, and are high digestive fibers.

The last category is Absorption.

This Metametrix test provides a great deal of information. Much is known about the gut, but much is unknown. It is beginning to dawn on doctors that the gut might have something to do with immune function and chronic illness. In this Patient Advocates estimation, certain parts of the test are more important than others, particularly since there are treatments that can bring improvement. Certainly identifying pathogens, high enterococcus, high streptococcus, high prevotella, inflammation, low good bacteria can all point towards various treatments, diet, pharmaceuticals, probiotics, and herbs, that can bring improvement to the gut ecology.

And then there is the idea about biofilms that fills the CFS forums these days. What effect biofilms have on gut ecology is another story for another day.

Comments, corrections, suggestions, additions, and/or clarifications are welcome.