Saturday, October 06, 2018

Coconut - the downside for ME CFIDS patients - possible TH2 shifting.

Further to my previous on problems with food. I have recently chanced upon a research paper which describes a phenomenon which may explain the symptoms I have been getting.

The experiment involved mice being fed coconut oil, which made a significant percentage of them vulnerable to TH2 shift and inflammatory reactions including anaphylaxis.

Dietary medium-chain triglycerides promote oral allergic sensitization and orally induced anaphylaxis to peanut protein in mice.
J. Li et al.


Dietary MCT promote allergic sensitization and anaphylaxis by affecting antigen absorption and availability and by stimulating Th2 responses.
MCT stands for medium chain triglycerides. In this case derived from coconut oil, which is considered a health food and often recommended for ketogenic dieting. The evidence applies only to mice but...

Over the last 5 years I have been suffering from summer headcolds which included severe oedemas in the upper respiratory tract. These may be an exacerbation of a previous tendency to TH2 shift in the summer since ME onset in 1986. The difference between these limited inflammations and the whole body response of anaphylaxis is that these oedemas were localised to tissues where an immune response was ongoing. If a virus is involved it remains unidentified but this condition was accompanied by intercostal cramps and tendency to hives, possibly headaches too and these lesser symptoms are apparently recurrent for me, fit the diagnosis of enterovirus, possibly echovirus which may be recurring like another repeatedly diagnosed virus does for me (HSV2 diagnosed by PCR still recurs 6 to 12 times a year, 32 years after infection, which triggered ME in the context of previous diagnosed EBV). This may be a result of the D in CFIDS (chronic fatigue immune dysfunction syndrome) which causes atypical things to happen with my immune system.

The colds with oedema typically produced pronounced nasal polyps and completely blocked my right ear once as well. The oedemas involved in these headcolds were greatly exacerbated by eating honey and lime and also coconut oil which I construed indicated salicylates, as I mentioned in my previous blog.

Honey and lime drink, which I unthinkingly took for a cold remedy, contains a lot of salicylates from honey but also lime has caused me problems with photsensitivity since and I cant rule that out as a factor and lime and all citrus have been added to my foods-to-avoid list. Honey is also reputed to contain pollen including grass pollen to which I am allergic as proven by a skin test.

Coconut oil, which I was eating regularly over the years this happened, contains salicylates but also MCTs, so this makes it difficult to be sure what has happened, as the MCTs may have exacerbated the oedema by another route as per the paper above, which I may have confused with the effect of salicylates.

I felt the salicylate sensitivity was further corroborated by the fact that I did end up having to avoid green vegetables during oedemas and also afterwards a string of headaches appeared to be triggered by green veg. All low salicylate foods seemed to be more tolerable for me. But green veg may contain potential allergens in the form of lectins which is something I am trying to understand and the headaches were often accompanied by mild asthma which suggests an inflammatory basis but by what route the inflammation occurs I cannot be sure.

So to be honest I would not call this a conclusive level of proof for the salicylate theory. An alternative hypothesis is that I was allergic to the honey and the green veg due to increased absorption of allergens induced by MCTs. However this is why testing food intolerance needs to be based on results and not solely on theory and I continue to test the bounds of my diet to check I am not being neurotic without good reason or making my life harder than it needs to be through lack of awareness.

If a thing makes me ill I need to avoid it, I just need to understand what it is so I can apply the knowledge effectively. There are some things I wont test any more like nightshades and coconut, because the evidence is sufficient for me, the years I ate coconut I got oedema and since I stopped eating coconut the oedemas stopped. Salicylates/lectins sensitivity I will continue to test, albeit very carefully, because it is variable and not as severe if I am not eating coconut.

A reaction to allergens does not rule out exacerbation by salicylates either, which are known to promote oedemas in some people. This is probably not an allergic reaction in itself IMHO, possibly a result of the way salicylates can interfere with prostaglandin pathways etc. This is odd because salicylate is normally regarded as an anti-inflammatory, but salicylates do have a wide range of effects and there are close connections to the inflammatory pathways, not all of which are beneficial. It remains a mystery but if coconut MCTs played a part and altered my reaction to allergens and salicylates combined, then if I do not eat coconut MCTs any more I may be able to tolerate salicylates better.

For me a breakthrough came after noting the long term coincidence in timing of these oedema attacks and my use of coconut oil in cooking, in a concerted attempt 5 years ago to improve my dietary intake of healthy lipids. I decided to stop eating coconut oil last year and this year the headcold with oedema attacks have not recurred, unlike the previous 4 years.

I am still having problems with vegetables and headaches but I found reducing gluten and including apple cider vinegar in my diet seemed to help.

It is my belief that somehow MCT coconut oil was setting me up for inflammatory reactions by some effect comparable to the observed TH2 shifting in mice (TH2 stands for T-helper cell type 2, which is the pro-allergic pathway,) and increased allergen absorption at Peyer's patches and this was behind my apparently new food intolerances.

TH2 shifting is known to be a vulnerability for ME CFIDS patients. Dr Paul Cheney identifed this clinically a long time ago and a recent paper from Maddy Hornig et al corroborates this diagnosis.

Cytokine network analysis of cerebrospinal fluid in myalgic encephalomyelitis/chronic fatigue syndrome.
M. Hornig et al.
Our results indicate a markedly disturbed immune signature in the cerebrospinal fluid of cases that is consistent with immune activation in the central nervous system, and a shift toward an allergic or T helper type-2 pattern associated with autoimmunity.

It occurs to me at the time of writing that its not impossible that the TH2 shift which may apply in my case due to ME CFIDS exacerbated by coconut MCT  might create a situation in which I developed an allergy to a latent virus, hence the strange mix of symptoms I experienced.

Hopefully avoiding coconut will mean I can avoid oedema reactions in future. Though if it is MCTs then its not just coconut as palm oil also has a high fraction of MCTs, though palm oil's capacity for allergic sensitisation has not been specifically tested and probably ought to be. Dairy also has them but I dont eat dairy anyway due to previous problems with it exacerbating summer allergies which I put down to casein at the time but on reflection may have been the same phenomenon.

I count myself lucky the oedemas caused, apparently by infection, when eating coconut were only in my upper respiratory tracts and not in vital organs. But this is a potentially dangerous phenomenon and something I feel its my duty to bring to other peoples' attention, despite the fact my understanding of it is incomplete.

I have now recovered from those episodes but coconut is definitely off the menu.


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