N=1: Is this my fault?

I'm writing this from the Remicade chair, 4 weeks after my last dose. As many of you know, the ideal timing is 8 weeks between doses - and generally I feel great after my infusions. But this last dose didn't "take". My ankle and toe are in constant pain, my elbows and hips are sore, and I'm very, very fatigued.

I'm desperately hoping this isn't the first sign of a downward trend. If my honeymoon with Remicade is over, then in a few months I'll be back to the drawing board... again. The fab rheumatologist is even talking methotrexate again - God forbid. I hate that stuff.

When you have a chronic illness, and you feel bad... wait, scratch that, I'm generalizing.

I have a chronic illness, and when I feel bad, I blame myself for my illness. Everyone has some crazy, and this is clearly my crazy talking. I know I can't control my illness. Yet, somehow, those taunting, bitter voices in my head take over and point the finger: at my diet, at my rate of exercise, at that night (ok, nights) in England 20 years ago when I drank way too much, at my lack of blogging. (Because, after all, blogging does prevent psoriatic arthritis). Ha.

I have this elusive feeling that if I could just do ________ (fill in the blank, crazy voices) I would feel better. I just wish I could figure out what _______ is.

So, I'm going to start back on the autoimmune diet, in a week, once this Remicade does has or hasn't kicked in for sure. I'm reading Pagano's book "Healing Psoriasis". I don't know if it will work. But it is something active I can do, instead of being a passive participant on this ride.

I'm falling asleep now (Remicade does that to me), but tomorrow I'll post this great article I just found about how diet can affect autoimmune illnesses. Sleep is good for me too, right?

More on calorie restriction

Just wanted to point out that today's New York Times Magazine has an article on the Calorie Restriction Diet, in case folks want to read more on the current thinking on this health topic. (This is in reference to my previous post).

Here's the link.

BTW - the whole magazine is about food... really good stuff!

I'm going on a diet, and here's why...

An article in the New York Times caught my eye today. It inspired me to get out of my back to school and so much to catch up on so why the heck did I get that puppy when the cat died funk, and start writing again.

(yes, we got a puppy. By the way: puppy + psoriatic arthritis = really achy joints, a few second thoughts and lots of laughing. Back to the science - more on puppy later.)

The NYT's front page story was on autophagy, which was described as:

Our cells ... perpetually devouring themselves, shredding their own complex molecules to pieces and recycling them for new parts.

Apparently, we all have proteasomes and lysosomes, two types of small structures inside of cells that are recycling machines. They work day and night eating cells and spitting out the remains, which are used to build new cells. One scientist was quoted saying that we get an entirely new heart every 3 days due to the continual cell destruction and re-creation. WOW.

Scientists are now starting to believe that autophagy (or the lessening of autophagy as we get older) has a lot to do with the development of Alzheimer's and cancer. While autophagy doesn't necessarily cease as we age, it slows down, causing more and more cells to live longer and therefore mutate, leading to illness. The current thinking is that if we can control autophagy, we may live longer.

OK, fellow autoimmune specialists... doesn't "autophagy" remind you of another cellular process we're all really familiar with? Isn't autoimmune disease caused when our immune system (different cells, I know, but...) destroys our own cells mistakenly? Couldn't autoimmune disease be related to autophagy? And, could this slew of new research also support research in autoimmune disease?

It turns out that scientists are starting to connect the dots between autophagy and autoimmunity. While the NYT article doesn't mention autoimmune disease, there is some great work out along these lines:

The connection between autophagy and immunity should be emphasized in that autophagy contributes to the defense against microbial agents [5, 12], promotes antigen presentation through MHC class II [13, 14], is induced by cytokines [5, 15, 16], may regulate T lymphocyte survival and function [17], and may be stimulated by serum autoantibodies [18].

This is from an article by a ton of docs (Ana Lleo, MD, Pietro Invernizzi, MD PhD, Carlo Selmi, MD PhD, Ross L. Coppel, MD, Gianfranco Alpini, PhD, Mauro Podda, MD, Ian R. Mackay, MD, and M. Eric Gershwin, MD) linking autoimmunity and autophagy in the Journal of Autoimmunity (2007). The article is long and complex, so I'll cut to the chase. They conclude:

In the context of immunity, there is clear evidence for participation of autophagy in intracellular defense against infectious agents and also perhaps, in disposal of unwanted e.g. misfolded self proteins, although there is no evidence yet for an ensuing inflammatory response to such disposal.

As always, lots to learn on this topic, but there are some smart people out there trying to put all these pieces together. I'll keep watching, and will write more when I learn more.

OK, so I can hear you asking: "why the diet?".

Here's why. Autophagy kicks in when our bodies have fewer new proteins coming in... you've all heard of the process where our body starts "eating" itself when it has less food. And it is well documented that people on permanently lower calorie diet are healthier... turns out semi-starvation is kinda good for you. Scientists think that inducing this "cannibalism" increases the destruction of older, dysfunctional cells - those that cause Alzheimer's and cancer. So I wonder if the same is true of autoimmunity. In short:

Would a lower calorie diet induce autophagy, and help our bodies destroy those cells that are mis-firing and causing our immune systems to act up?

BTW, because of the dog, I've lost 3 pounds, just from walking. I look fabulous. And if I just stop eating, I'll apparently be able to walk the dog 'til I'm 150.

Where's the leash?