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How to Prevent the Infection that May Trigger Type 1 Diabetes

The compelling finding of Mycobacterium avium paratuberculosis (MAP) circulating disproportionately within the bloodstream of type 1 diabetics was subsequently confirmed by culturing it straight out of their blood. MAP infection and type 1 diabetes appear to go together, but we didn’t know which came first. Does the infection make kids more susceptible to diabetes? Might diabetes make kids more susceptible to infection? Maybe this MAP bug just likes hanging out in sugary blood. In that case, we might expect to also see it in type 2 diabetics, but, no: Paratuberculosis infection is not associated with type 2 diabetes, which makes sense since type 2 is not an autoimmune disease.

In order for the idea of MAP infection triggering type 1 diabetes to be sound, there would have to be an immune response mounted to the bug, and, indeed, there is. Researchers in Sardinia found an “extremely significant” antibody response against paratuberculosis (paraTB) bacteria in type 1 diabetics. But do the antibodies attacking the bug cross-react with our own insulin-producing cells to generate that autoimmune reaction? Apparently so. Antibodies recognizing the molecular signatures of MAP cross-react with the molecular signatures present on our insulin-producing beta cells in the pancreas, as you can see at 1:09 in my video Does Paratuberculosis in Meat Trigger Type 1 Diabetes?.

Is this just in Sardinia, or might we find these same results elsewhere? The same results were in fact found on mainland Italy with a group of type 1 diabetics “with a genetic background different from Sardinians”—a strong association between paraTB bacteria exposure and type 1 diabetes. The findings were confirmed in further studies, confirmed once more in other pediatric populations, and confirmed in a group of type 1 diabetic adults, as well.

The paratuberculosis bacterium may also explain why type 1 diabetes risk is associated with a specific gene on chromosome 2 called SLC11A1. What does that gene do? SLC11A1 activates the immune cell that eats mycobacteria for breakfast. This could explain how a mutation in that gene could increase the susceptibility to type 1 diabetes—namely, by increasing the susceptibility to mycobacterial infections, like Mycobacterium avium paratuberculosis. Indeed, an “[a]ccumulating line of evidence points…[to] MAP in the development of T1DM [type 1 diabetes] as an environmental trigger.” It’s likely no coincidence. These types of bacteria have evolved to disguise themselves to look like human proteins for the express purpose of avoiding detection by our immune system. These are not the droids you’re looking for. If, however, our immune system sees through the disguise and starts attacking the bacteria, our similar-looking proteins can become a victim of friendly fire, which is what nearly all of these studies have been pointing to. Nearly, but not all.

A 2015 review found that seven out of seven human studies found an association between type 1 diabetes and paratuberculosis exposure, but it’s actually seven out of eight. Since that review came out, a study in India was published finding no link. A few possible explanations were offered. Maybe it’s because vaccination for regular TB is compulsory in India, which might offer “cross protection from MAP as in case of leprosy,” or because they eat so much less meat due to “certain cultural and culinary practices such as widespread vegetarianism,” or because of their “compulsory boiling of milk before consumption…” If we measure the heat inactivation of milk with high concentrations of naturally infected feces, which is probably the main source of milk contamination, pasteurization may not completely inactivate the bacteria, but sterilization at boiling temperatures should (as you can see at 3:40 in my video). This may depend on the degree of fecal clumping, though. MAP bacteria may be able to ride out pasteurization by hiding in tiny fecal clumps in milk, but only rarely should MAP survive over 100 degrees Celsius, perhaps explaining the disparate India findings. 

Bottom line: “To reduce human exposure to MAP via consumption of dairy and meat products…[more] studies are needed for estimating the amount of MAP” in milk, meat, and feces, as well as “the amount of faecal contamination of milk and carcasses [meat]” to figure out what we need to do to kill it. In the meanwhile, what’s the potential public health impact of Mycobacterium avium paratuberculosis? The majority of specialists in the field agree that it “is likely a risk to human health” and should be “a high- or medium-priority…public health issue.” 


I started speaking out about the link between human disease and paratuberculosis infection in milk and meat 15 years ago. As cynical as I can be at times, even I am shocked that the industry hasn’t done more to clean up its act. It reminds me of the bovine leukemia virus story. See:

If you missed the first two installments in this series, check out Does Paratuberculosis in Milk Trigger Type 1 Diabetes? and Meat Consumption and the Development of Type 1 Diabetes.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


54 responses to “How to Prevent the Infection that May Trigger Type 1 Diabetes

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    1. Deb,

      I’m sorry to hear about your brother; the waiting and uncertainty must be so difficult for all of you.

      Meanwhile, I watched a bit of your Dr. Popper video; 6 minutes, of which her own opinions were about 3 min, was more than enough. Today, I waited in a line to enter a grocery store, in the rain, at a socially appropriate distance, for more than 20 min. Though it almost seemed worth it: the shopping experience was so much better than usual!! So uncrowded. But the store had posted aisle directions (most of the shoppers missed them, including me), there was a wait line to check out at the correct distance, re-usable bags were not allowed in, almost everybody wore masks and most people had gloves.

      Are the measures perfect? No. But they are better than they were. It seems to be a work in progress. And, as this Dr. Popper mentioned, we do need to buy food. But we don’t need to get our nails done. Or even go out to eat. Or to the library. (She seems quite aggrieved that she can no longer avail herself of these non-essential services). And we are in the grocery store for a lot shorter period than we would be when eating out, and getting our nails done. And I’ve read that disease transmission involves sustained close contact, indoors, for about 30 – 60 minutes. which is what happens getting your nails done, or eating out at a restaurant. Not so much at the grocery store.

      And then, there is the risk to the workers in these non-essential services; she doesn’t seem to consider their risk, just the risk to herself, and other customers.

      1. Dr. J.,

        Yes, the essential workers are getting it left and right and I agree with you.

        We are mildly inconvenienced, but people are dying even that we didn’t take it further.

        I am praying my brother won’t be one of them.

        He has been so careful and we have had a minimum of 20 feet distance for a long time, but we did have 1 worker come in and he didn’t say that he should have been quarantined.

        They weren’t in close proximity.

        And, my sister-in-law walked around the shop spraying Lysol multiple laps around it.

        And yet my brother failed his chest scan.

        He hasn’t been going places or socializing.

        He is an essential worker and I will cry my eyes out if I didn’t do enough.

        1. There is also the fact that it will be the minorities who die at much higher levels.

          I wouldn’t have called it racism, but now is where we decide whether protecting them is necessary or not and that is where genuine racism gets exposed.

          The darker complexion people already aren’t being told to take Vitamin D and weren’t informed about it back when it might have helped them to not get cancer and not die from cancer.

          That study only wrote about it as a throwaway thought buried within the text and it was not in any of the headlines.

          1. I will say that there is a genuine sense of people don’t care about “other” that I already see.

            I talk to my female friends and they are so happy that it is 75% males and the young people are saying, “It isn’t going to affect me anyway.” and nobody is all that protective over the elderly community.

            I could lose so many people who I love so much.

            My friend told me that I shouldn’t follow it so closely, but following the science and the advances in medicine and how to regrow supermarket lettuce and how to make masks and all that I learned about disinfecting and sanitizing is how I protect my loved ones.

            Them not caring is what I find stressful.

            And me sharing at all is stressful to them.

            I told them, I need to not interact with the rest of you because I need to keep learning.

            Here is how to regrow supermarket lettuce.

            https://www.youtube.com/watch?v=J9mRHPGSHmM

            1. And, no, we didn’t fight.

              They moved to locations that don’t have as many cases and that is another “other” who we don’t really care about.

              We care about our own.

  1. I am very interested in learning more about what causes Type 1 Diabetes and the interactions that MAP has on humans with the disease. Are we then to think that an antibiotic and diet change can cure Type 1 diabetics? You have presented a lot of information on potential causes but unless I missed it I have not seen discussions for curing the disease. Is there a cure with diet and/or medicine alone? Can a diabetic meat-eater switch to a plant based diet and be cured?

  2. Fascinating confirmation about MAP and T1D.
    My haplotype is not a “typical type one diabetes” profile according to DRI geneticist Dr. Pugliese.
    My father, a physician wrote books about telepathy and psychic phenomena. I was raised in a very intuitive and aware family. At age 6 I declined to drink milk. My parents pushed me to drink it. I added sugary chocolate mixes to hide the taste until my parents let me not drink it. By the time I turned 8, I avoided meat SS much as I could, even burned my meat on the grill when given a chance. When diagnosed before my 12th birthday I admitted I had GIVEN my meat at mealtime to our dog and my parents no longer made me eat meat. I have lived with T1D for over 50 years now and avoid processed foods. I have not eaten meat nor used milk for decades. I do not produce any insulin as shown by special tests.
    This reader h looks very promising for others.

    1. Lisa,

      Our parents didn’t know.

      And that is the truth.

      The next generation will have the information.

      I wonder if they will have the self-control to listen to it?

  3. My brother couldn’t get tested today.

    The hospitals keep running out of tests and are only testing the first 40 people who show up.

  4. I thought milk protein casein or such caused the immune reaction that destroyed beta cells; circulating antibodies to milk protein has been found in ?>90% of type 1 diabetics?

    1. There are a number of hypotheses about why milk consumption appears to be associated with T1D As well as particular proteins in milk, there is also an argument that bovine insulin may be a factor. There are probably ,multiple risk factors at work but nobody really knows for sure

      https://nutritionfacts.org/video/does-bovine-insulin-in-milk-trigger-type-1-diabetes/
      https://nutritionfacts.org/video/does-casein-in-milk-trigger-type-1-diabetes/

      1. Tom, indeed there are multiple factors at play. The following are my comments on the latest video from Dr Greger. They were blocked over 5 hours ago, which is ‘their’ way of excluding my comments on this subject. Lets see if it get through this way…

        Pete Granger says: April 9th, 2020 at 8:35 pm *Your comment is awaiting moderation.*

        ………

        I appreciate this report being factual and demonstrating a real understanding of the issue. Notwithstanding Dr Greger’s bias against milk, it at least attempts to be objective:

        A few comments though:

        1. I think it is fairly safe to say type 1 diabetes is not associated with milk proteins.
        2. I completely agree the dairy industry has not done enough to address the issue of paratuberculosis (a separate issue).
        3. Paratuberculosis is a theoretical risk for type 1 diabetes, however it is one of many risks – most of which seem more likely than paratuberculosis.
        4. The distribution and amount of paratuberculosis in milk is miniscule.
        This does not preclude it as a risk factor, but makes it less likely. It appears to be derived from somatic cells in the udder.
        5. Paratuberculosis is mostly destroyed by pasteurisation, but not in all cases. When it is present, the count is very low.
        6. Paratuberculosis is destroyed by UHT processing (135 degrees C), and probably (but not for certain) spray drying (milk formula). A new form of pasteurisation (LTST) pasteurises milk under pressure. This may well eliminate paratuberculosis, but it is too early to say.
        7. Those who are concerned about paratuberculosis (a family history of type 1 diabetes) might consider full cream sterilised liquid milk formula (ready to use) if needed in children up to 6 months, and perhaps UHT milk (as part of a complete diet) thereon. Fortuitously, the protein in UHT milk may be more digestible.

        ‘In conclusion, it appears that feeding UHT-treated formula or powdered formula with a protein concentration of 13 g/L results in satisfactory growth, hematology, trace element status, and plasma amino acid patterns as compared with breast-fed infants.Concentrations of several amino acids and BUN in infants fed this amount of protein are closer to those of breast-fed infants than are corresponding values from infants fed formula with 15g protein/L. In addition, low serum transferrin receptor concentrations in the group fed the UHT-treated formula with 13 g protein/L suggest that iron was well utilized from this formula.’

        https://watermark.silverchair.com/350.pdf https://www.ncbi.nlm.nih.gov/pubmed/9701193 https://www.sciencedirect.com/science/article/abs/pii/S0260877416300334

        8. The Sardinian study quoted by Dr Greger has a problem. Sardinia has the second-highest insulin dependent incidence of type 1 diabetes in Europe after Finland. However, this incidence is three times higher than predicted by its milk consumption.

        https://www.ncbi.nlm.nih.gov/pubmed/1425096 https://care.diabetesjournals.org/content/17/4/346

        That is, its milk consumption and incidence of type 1 diabetes does not support the theory that milk is responsible.

        9. There is no clear association between milk consumption and type 1 diabetes:

        ‘Some researchers believe that a viral infection can activate the immune system in such a way that it moves on to attack the islet cells after it has cleared up the virus. Others believe immune reactions to certain foods could be the trigger. Dr. Cummings is the Halifax lead of an international study that’s looking into the possibility that early exposure to cow’s milk proteins could set off the immune events that cause some children to develop type 1 diabetes’.

        https://dmrf.ca/researchers/dr-beth-cummings/ Cow’s milk and Type 1 diabetes? International study disproves link By Alexa MacLean Posted January 16, 2018 ‘Dr. Cummings was the lead investigator for the Halifax team that followed more than 2,000 infants over the first decade of their lives, some even longer.’

        ‘The goal of the international study, conducted in over 15 countries, was to determine whether what children were fed at an early age — primarily cow’s milk protein — had any impact on them ultimately acquiring the disease’.

        “What this study has shown is that we’re not finding any connection (with milk). So, Type 1 diabetes is mostly something you inherit a risk for from your family members, that’s about 50 per cent of the risk. The other 50 per cent, we don’t understand and that was the point of this study,” Dr.
        Cummings said’.

        https://globalnews.ca/news/3968687/cows-milk-and-type-1-diabetes-international-study-disproves-link/

        Note: We are not finding any connection with milk !

        ‘In an extended, secondary analysis of a population-based cohort, very early exposure to cow’s milk is not a risk factor for type 1 diabetes; it may in fact DIMINISH its appearance before age 8.’

        https://www.ncbi.nlm.nih.gov/pubmed/19263185/

        ‘Together with existing evidence from human cohorts7,8 and a T1D mouse model9, these data support the protective effects of short-chain fatty acids in early-onset human T1D’.

        (note: milk fat is rich in short-chain fatty acids)

        https://www.ncbi.nlm.nih.gov/pubmed/30356183

        There is only a theoretical risk of milk being implicated (paratuberculosis), but despite the best efforts of scientists this is not translating into cause. Moreover, there is also a theoretical possibility milk protects against type 1 diabetes !

        9. Scientists believe genetics is responsible for about 50% of the risk of type 1 diabetes, and the rest is multifactorial. There is no single environmental trigger. Most likely there are multiple triggers in combination. Ultra-hygiene, viruses, vitamin D, latitude, rare metals, shift from rural to urban living, and so on. Viruses are high on the totem pole, and paratuberculosis low on the totem pole – but cannot be categorically excluded.

        10. It may not have relevance, but milk consumption is associated with a ‘markedly reduced’ risk of type 2 diabetes: ‘The consumption of milk and dairy products is associated with a markedly reduced prevalence of the metabolic syndrome, and these items therefore fit well into a healthy eating pattern’.

        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2652996/

          1. Thanks Steve for your explanation, which of course I accept. Apologies for any imputation.
            However, it is somewhat confusing. Their algorithm seems quite indiscriminate. Sometimes these sorts of posts sail through other times they are blocked. Frequently, as in this instance, they are blocked if it is an original post, but waved through if it is a reply to someone else’s post.
            I accept the need for automated blocking, but this is a very blunt instrument. It would benefit from some additional rules which conditionally and automatically permit posts from ‘known’ users, or the ability for the system to challenge the identity of the poster, or immediately refer the post for personal or even automated review (did not happen in this instance as the original post still has not been published). That is, if it is a post from a ‘legitimate’ user, your system could automatically authenticate the post. I am sure it is complicated, but just some suggestions on how the problem might be minimised. With the caveat they are all cheap options.
            Cheers.

        1. Thanks Pete.

          Unfortunately, I don’t have time to read all your references.

          I did look at the last one which seems uncharacteristically enthusiastic about dairy for an academic study. It actually excluded people with diabetes from the analysis. I note that the lead author Professor Peter Elwood has also published a large number of other articles which are similarly enthusiastic about dairy. He is a seemingly tireless advocate for dairy. However, he is most famous for setting up the Caerphilly heart disease study. Caerphilly in turn is most famous for the eponymous cheese – very nice it is too if I remember correctly.

          I think I would probably agree that replacing calories from meat and junk food with calories from dairy would be relatively healthy (ie it would be less unhealthy than meat and junk foods).

    1. Fascinating. BCG is an ancient therapy which is used in recent years as the ‘gold standard’ intravesical treatment for difficult bladder cancer. It is also being trialed at present as a vaccination to protect health workers at the interface with Corona virus patients….
      It boosts the immune system. If it were to work with type 1 and type 2 diabetes, it suggests the immune response is inadequate or impaired in these patients, and this is reversible.

      1. Pete,

        The immune response part might be reversible for a while but nobody has figured out how to reverse the damage after the body stops manufacturing insulin yet.

      2. “The BCG vaccine against tuberculosis can reverse Type 1 diabetes to almost undetectable levels, an eight-year study has shown.

        US researchers found that just one jab, followed by a booster four weeks later, brought down average blood sugar levels to near normal within three years, and the effect lasted for the following five years.”
        https://www.telegraph.co.uk/science/2018/06/21/bcg-vaccine-can-reverse-type-1-diabetes-almost-undetectable/

          1. When I first saw this study it made me think about the symbiotic relationship between worms and suppression of the allergy response. I believe this could be another symbiotic exposure that has some benefits.
            it’s only one of the three tuberculosis vaccines that works and it happens to be the form of tuberculosis that is not dangerous that they used for that particular vaccination.

          1. …it seems promising, but too early to say.

            https://www.jdrf.org/blog/2018/06/25/joint-statement-from-jdrf-and-the-american-diabetes-association/

            Despite this being a safe vaccine which has been around for yonks it has taken 10 years to learn ….not a great deal. Other than it is a promising treatment. One wonders what is the hold up?
            Its a shame they dont treat it the same as the Carona virus vaccine – years or decades of research magically compressed into months.
            I sometimes think they apply the taxi-driver principle. The longest route to the destination is the most lucrative.

            1. Good find Pete. Thanks.

              Since people still need insulin therapy, it is hardly reversing T1D to nearly undetectable levels as claimed in that Daily Telegraph article. It should nevertheless be a boon to type 1 diabetics if it works out.

              Perhaps,the problem is that the BCG vaccine is off-patent and there is no money to be made from it? So nobody is interested in funding further research.

              Also the US has always discouraged its use because of of the ‘low risk of infection with Mycobacterium tuberculosis.’ (Or possibly because it isn’t a US vaccines and US vaccine manufacturers had an alternative product?)
              https://www.cdc.gov/tb/publications/factsheets/prevention/bcg.htm

              1. Tom,

                All of that may be true, plus some complicating medical factors.

                Its always a worry when you have a ‘revolutionary’ new treatment which has been in the development pipeline for a decade, and not much to show for it.
                Particularly if it is a well established drug being repurposed. It can suggest it is problematic in some way.
                Co-administration of insulin is not necessarily a deal-breaker, but it may rule out non-insulin-dependent type 2 diabetics.

                BCG appears to enhance the assimilation of glucose by safely boosting TNF.
                With the emphasis on ‘safe’.

                More specifically, BCG may (a) eliminate autoreactive T cells that attack the pancreas and (b) enhance regulatory T cells that prevent autoimmune reactions (c) shift glucose metabolism from oxidative phosphorylation, to aerobic glycolysis.
                Seems to me (a) and (b) are only useful if beta cell destruction is progressive, which is more likely in adults and less so in children.
                (c) seems more universally applicable (see following), but the research seems more focused on (a) and (b).

                Incidentally, the (errant) boosting of TNF is also largely responsible for the cytokine storm that overwhelms certain vulnerable corona virus patients. Conversely, it helps protect health care workers at the corona-virus interface. So its obviously a useful but tricky thing to manage.

                The BCG studies demonstrate an initial 10% reduction in Hba1c levels – which (counter-intuitively) progressively doubles over time. Until the reduction ceases altogether.

                BCG (as a treatment) is unique in shifting glucose metabolism from oxidative phosphorylation, to aerobic glycolysis. This re-programs metabolic genes – enhancing glucose consumption by the body’s cells. Hence the benefit in this instance. In effect, it transforms normal cells into energy-voracious fetal cells. The latter are programmed to accommodate exponential growth in the womb. This transformation (regression) is probably the body’s way of generating additional energy when it is under viral or bacterial attack. Interestingly, it is also the same energy pathway hijacked by cancer (the Warburg effect) enabling it to multiply exponentially. So, conceivably this may also be a complicating factor in this treatment.

                One expects that inducing aerobic glycolysis has the same potential to reduce blood sugar in type 2 diabetics. There are mice studies which support this, but surprisingly, there does not appear to be any human studies. Perhaps there are complications we don’t know about.

                The research has been in the pipeline since 2001 (yikes), and is being privately funded by philanthropists, including the Iacocca Foundation.
                Maybe they are in no great hurry…

                1. Pete,

                  This is an interesting discussion for me. I have 2 friends who are T1D. I have told them about it since Tom posted it and now I will have to do the extra work because “too good to be true” does happen sometimes, but it is rare enough to make me suspicious when it is about drugs that never showed up on the scene.

                  But it has happened enough in my life that I know that things like WFPB are things that often just plain work.

                  The vaccine possibly helping to prevent COVID is already good enough reason to take a second and third look, particularly if Dr. Klaper is right that COVID may disappear over the Summer and come back like the flu from now forward.

                  1. The UK NHS has some info on who shouldn’t have the BCG jab (the WHO simply says it is not recommended for people over 16):

                    “The BCG vaccine is not recommended for:

                    . people who have already had a BCG vaccination
                    . people with a past history of TB
                    . people with a positive tuberculin skin test (Mantoux)
                    . people who have had a previous severe allergic reaction (anaphylactic
                    reaction) to any of the substances used in the vaccine
                    . children under 2 years of age in a home where a case of active TB is
                    suspected or confirmed
                    . people who have a septic skin condition at the site where the injection would
                    be given
                    . people with a weakened immune system, either as a result of a health
                    condition such as HIV, treatments such as chemotherapy, or medicines that
                    suppress the immune system, such as steroid tablets
                    . people who have cancer of the white blood cells, bone marrow or lymph
                    nodes, such as leukaemia or lymphoma
                    . people who are seriously unwell (vaccination should be delayed until they
                    recover)
                    . pregnant women
                    BCG vaccinations are not usually offered to people over the age of 16 because the vaccine does not work well in adults.”
                    https://www.nhs.uk/conditions/vaccinations/when-is-bcg-tb-vaccine-needed/

                    I suppose that BCG uses a live (attenuated) TB agent and people with weakened immune systems would be at risk of getting from the vaccine

                    However, the above is all about TB not T1D.

                    Nevetheless, people would need to discuss this with their doctor although I suspect that many physicians would be unwilling to sanction such off-label use in the absence of larger and more compelling studies than this.

                    1. Tom,

                      The incidence of Type 1 diabetes is 11.2 per 100,000 child years, and increasing. https://www.ncbi.nlm.nih.gov/pubmed/30410744

                      Just thinking the increase in type 1 diabetes in children may be due to the declining use of routine BCG vaccination. That is, BCG may be protective against type 1 diabetes, particularly in those exposed to (say) paratuberculosis. Given the response to BCG is highly variable, this may be difficult to ascertain. Nonetheless, I found some references which may support the hypothesis:

                      *‘The genetic background, the differing assessment of human exposure to the mycobacterium and the different coverage rates of Bacillus Calmette-Guérin (BCG) vaccination between populations are all important determinants of susceptibility to the disease (MS). Regarding BCG, clinical trials have shown a vaccine-associated reduction in symptom severity among patients with MS and clinical isolated syndrome [**17**], however, the mode of action has not yet fully elucidated’.*

                      https://www.futuremedicine.com/doi/10.2217/fmb-2019-0102

                      Sweden and the Nordic countries have a very high incidence of type 1 diabetes.

                      *Finland …..has the highest incidence in the world of type 1 diabetes (T1D) among children. Sweden …has the second highest incidence.*

                      https://care.diabetesjournals.org/content/40/10/e143

                      *‘Previously all children were vaccinated against TB in Finland. Since 2006, BCG vaccine is given only to children who are considered to be at increased risk for catching TB’.*

                      https://tuberkuloosi.fi/en/tuberculosis/vaccination/

                      *‘In 1975 the BCG vaccination policy in Sweden changed from routine vaccination of all newborn infants to selective vaccination of groups at higher risk’. *

                      https://www.ncbi.nlm.nih.gov/pubmed/16567880

                      ‘In April 1975, the mass vaccination of newborns against tuberculosis was replaced by selective vaccination of groups at risk. BCG coverage fell from more than 95% before 1974 to 1.8% between 1975 and 1982 and thereafter reached an average of 13.7% up to 1989’.

                      https://www.ncbi.nlm.nih.gov/pubmed/1421348

                      Sweden has a high incidence of type 1 diabetes. This study suggests children are contracting the disease earlier.

                      https://www.ncbi.nlm.nih.gov/pubmed/12107721

                      ….’the continued low incidence of tuberculosis in Swedish children up to and including 1980 does not justify the reintroduction of general BCG vaccination of the newborn in Sweden’.

                      https://www.ncbi.nlm.nih.gov/pubmed/6604357

                      …..’exposures affecting young children may be responsible for the increasing incidence in the younger age-groups’.

                      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3142045/

                      The following study demonstrates that the incidence of MS is much higher in males than females. Why?

                      *‘The incidence of type 1 diabetes …..was in all age groups higher in men, yielding an overall male/female ratio of 1.8’. *

                      https://www.ncbi.nlm.nih.gov/pubmed/18205768

                      Another study demonstrates women mount a stronger humoral response to mycobacterial peptides than men. Is it delivering females greater protection against paratubercolosis?

                      https://www.mdpi.com/2077-0383/7/12/522

                    2. Thanks Pete.

                      That sounds plausible although T1D rates have also been increasing in the US where the BCG vaccine was never routinely given to children.

                      Also, I understand that women have better immune systems than men generally. One possible explanation is that women have two X chromosomes whereas men only have one. Another explanation is that oestrogen plays a protective role in boosting immunity.

  5. I appreciate this report as being factual and demonstrating a real understanding of the issue. Notwithstanding Dr Greger’s bias against milk, it at least attempts to be objective:

    A few comments though:

    1. I think it is fairly safe to say type 1 diabetes is not associated with milk proteins.
    2. I completely agree the dairy industry has not done enough to address the issue of paratuberculosis (a separate issue).
    3. Paratuberculosis is a theoretical risk for type 1 diabetes, however it is one of many risks – most of which seem more likely than paratuberculosis.
    4. The distribution and amount of paratuberculosis in milk is miniscule. This does not preclude it as a risk factor, but makes it less likely. It appears to be derived from somatic cells in the udder.
    5. Paratuberculosis is mostly destroyed by pasteurisation, but not in all cases. When it is present, the count is very low.
    6. Paratuberculosis is destroyed by UHT processing (135 degrees C), and probably (but not for certain) spray drying (milk formula). A new form of pasteurisation (LTST) pasteurises milk under pressure. This may well eliminate paratuberculosis, but it is too early to say.
    7. Those who are concerned about paratuberculosis (a family history of type 1 diabetes) might consider full cream sterilised liquid milk formula (ready to use) if needed in children up to 6 months, and perhaps UHT milk (as part of a complete diet) thereon. Fortuitously, the protein in UHT milk may be more digestible.

    ‘In conclusion, it appears that feeding UHT-treated formula or powdered formula with a protein concentration of 13 g/L results in satisfactory growth, hematology, trace element status, and plasma amino acid patterns as compared with breast-fed infants.Concentrations of several amino acids and BUN in infants fed this amount of protein are closer to those of breast-fed infants than are corresponding values from infants fed formula with 15g protein/L. In addition, low serum transferrin receptor concentrations in the group fed the UHT-treated formula with 13 g protein/L suggest that iron was well utilized from this formula.’

    https://watermark.silverchair.com/350.pdf
    https://www.ncbi.nlm.nih.gov/pubmed/9701193
    https://www.sciencedirect.com/science/article/abs/pii/S0260877416300334

    8. The Sardinian study quoted by Dr Greger has a problem. Sardinia has the second-highest insulin dependent incidence of type 1 diabetes in Europe after Finland. However, this incidence is three times higher than predicted by its milk consumption.

    https://www.ncbi.nlm.nih.gov/pubmed/1425096
    https://care.diabetesjournals.org/content/17/4/346

    That is, its milk consumption and incidence of type 1 diabetes does not support the theory that milk is responsible.

    9. There is no clear association between milk consumption and type 1 diabetes:

    ‘Some researchers believe that a viral infection can activate the immune system in such a way that it moves on to attack the islet cells after it has cleared up the virus. Others believe immune reactions to certain foods could be the trigger. Dr. Cummings is the Halifax lead of an international study that’s looking into the possibility that early exposure to cow’s milk proteins could set off the immune events that cause some children to develop type 1 diabetes’.

    https://dmrf.ca/researchers/dr-beth-cummings/
    Cow’s milk and Type 1 diabetes? International study disproves link
    By Alexa MacLean
    Posted January 16, 2018
    ‘Dr. Cummings was the lead investigator for the Halifax team that followed more than 2,000 infants over the first decade of their lives, some even longer.’

    ‘The goal of the international study, conducted in over 15 countries, was to determine whether what children were fed at an early age — primarily cow’s milk protein — had any impact on them ultimately acquiring the disease’.

    “What this study has shown is that we’re not finding any connection (with milk). So, Type 1 diabetes is mostly something you inherit a risk for from your family members, that’s about 50 per cent of the risk. The other 50 per cent, we don’t understand and that was the point of this study,” Dr. Cummings said’.

    https://globalnews.ca/news/3968687/cows-milk-and-type-1-diabetes-international-study-disproves-link/

    Note: We are not finding any connection with milk !

    ‘In an extended, secondary analysis of a population-based cohort, very early exposure to cow’s milk is not a risk factor for type 1 diabetes; it may in fact DIMINISH its appearance before age 8.’

    https://www.ncbi.nlm.nih.gov/pubmed/19263185/

    ‘Together with existing evidence from human cohorts7,8 and a T1D mouse model9, these data support the protective effects of short-chain fatty acids in early-onset human T1D’.

    (note: milk fat is rich in short-chain fatty acids)

    https://www.ncbi.nlm.nih.gov/pubmed/30356183

    There is only a theoretical risk of milk being implicated (paratuberculosis), but despite the best efforts of scientists this is not translating into cause. Moreover, there is also a theoretical possibility milk protects against type 1 diabetes !

    9. Scientists believe genetics is responsible for about 50% of the risk of type 1 diabetes, and the rest is multifactorial. There is no single environmental trigger. Most likely there are multiple triggers in combination. Ultra-hygiene, viruses, vitamin D, latitude, rare metals, shift from rural to urban living, and so on. Viruses are high on the totem pole, and paratuberculosis low on the totem pole – but cannot be categorically excluded.

    10. It may not have relevance, but milk consumption is associated with a ‘markedly reduced’ risk of type 2 diabetes:
    ‘The consumption of milk and dairy products is associated with a markedly reduced prevalence of the metabolic syndrome, and these items therefore fit well into a healthy eating pattern’.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2652996/

    1. ‘Dr Greger’s bias against milk’

      You’re not exactly agnostic on milk yourself though are you Pete?

      Dairy may well be better than red meat and processed foods – and studies do appear to show this. However, they usually just look at milk consumption in the context of background diets that are high in meat, sugar, fat etc. There are few studies that look at dairy relative to other food groups. One that did is that Harvard study I have referred to before

      “For dairy lovers, the good news is that various foods including full-fat dairy milk, yogurt, butter, cheeses, and cream were not found to increase heart disease risk (compared to a background diet that typically contains high amounts of refined carbohydrates and sugars). However, it is important to note that these foods were not found to decrease risk either.

      What did predict risk of cardiovascular disease was “fat swapping.” When dairy fat was replaced with the same number of calories from vegetable fat or polyunsaturated fat, the risk of cardiovascular disease dropped by 10% and 24%, respectively. Furthermore, replacing the same number of calories from dairy fat with healthful carbohydrates from whole grains was associated with a 28% lower risk of cardiovascular disease.

      Replacing dairy fat with other types of animal fat, such as from red meat, predicted a modest 6% higher risk of cardiovascular disease.”
      https://www.hsph.harvard.edu/nutritionsource/2016/10/25/dairy-fat-cardiovascular-disease-risk/

      Basic arithmetic suggests that eating dairy (fat) in place of whole grains could increase my CVD risk by a whopping 39%. No thanks.

      1. Tom,

        Of course there is a potential bias by those who are paid by the dairy industry, but that’s not me. Unless you count three years employment over 40 years ago. Statute of limitations should apply? Its also not surprising there is an increasing ‘bias’ in favour of dairy amongst scientists – if they are reading the same studies I have over the past few decades.
        Predominantly reversing those dodgy studies done in the US around the time I was employed in the industry. Which, like many, I fell for hook line and sinker. Which had us eliminating dairy in favour of margarine and hydrogenated vegetable oils, and (more recently) inferior plant-based milks for cows milk. Pretty much a fool’s errand.

        For me its also a sentimental attachment to dairy. The 150 million family farms which underpin many rural communities (1000 broad acre soybean farms are hardly the same), the 260 million cows – including 40 million in India.
        Which some would have sacrificed as a species for their own good? A self-evidently illogical proposition. The abandonment of thousands of small dairies around the world producing their own cheese (often on a very small scale). [Highly recommend the TV series by Will Studd to gain a keen appreciation of this (https://en.wikipedia.org/wiki/Will_Studd)] . I respect the importance of milk in underdeveloped countries in the prevention of starvation, kwashiorkor, and stunting. The latter affecting one in four children in the world because of a lack of protein ( https://www.gatesnotes.com/Development/Why-Does-Hunger-Still-Exist-Africas-Table-Day-One).
        And the 60 million children in Africa without enough food ( https://www.theguardian.com/global-development/2019/jun/05/nearly-half-of-all-child-deaths-in-africa-stem-from-hunger-study-shows).
        Simply corrected if these children obtained adequate milk on a daily basis.
        I choose the survival of cows as a species, and family dairy farms and cheese factories, and feeding the starving if the price to be paid is that cows are milked. It may be a over-simplification, but to my mind its a fair exchange. Even if the food-fad industry (that’s what it is) plonks me in the political incorrect category. So, that’s my bias on the matter of dairy.

        I dont have a vested interest in the industry. Whereas best-selling author Dr Greger does have an obvious vested interest in promoting a vegan lifestyle. It biases every message he makes. It is tailored for his considerable audience, which is really a movement. Whether he is being sincere, cynical, or both. This is not an attack on his ability, which is considerable. It is an attack on his bias. Which he is entitled to have so long as he does not pretend he is being scientifically objective.

        As should be evident by now, I am nothing more than a counterpoint to this bias.

        1. I think that Greger is against dairy on principle. He can (and does) also point to substantial evidence that dairy consumption is not optimal even if it is better than eg red and processed meats, sugar etc Also, as a qualified and registered MD, I don’t think he is reliant on the books for his living (the profits from which go to the website which presumably pays his salary). You on the other hand spend most of your time here actively promoting dairy and are not by any means a disinterested commentator on the issue. As I’ve mentioned before, your depiction of Greger as biased is a pot calling the kettle black criticism. It’s also not clear to me whether any of your clients/customers are connected with the dairy industry …. but I think that like Greger your position here is based on principle or sentiment rather than conscious self-interest.

          The evidence we tend to dscuss here is largely about dietary choices made in wealthy advanced economies. In the Third World, adding dairy to a highly limited diet based on eg white rice, hydrogenated cooking oil, a few vegetables and occasional fatty meats might be beneficial (although most such populations are lactose intolerant). It was probably also beneficial 100 years ago in eg the UK where poor people lived on white bread, jam, fatty tinned meats and sweetened tea eg McCarrison. However, neither of these contexts is really Greger’s focus which is what is the optimum diet now for people in advanced economies who have a choice about the foods they eat Nor do such arguments even consider whether there are or were healthier alternatives to dairy in those circumstances.

          The economic impact on family farms etc is another issue. That”s no different from tobacco though and as a student, I worked briefly on a family tobacco farm in Canada. I’m sure the public health campaign against smoking must have been devastating for that family but that’s not a good reason to give tobacco a free pass any more than it is a good reason to give dairy a free pass.

          To be honest, I think you’d have a better case if you came at this from the US dietary guidelines perspective rather than attempting a blanket defence of all dairy. Mainstream nutritional,science in the shape of those guidelines seems to accept that full fat dairy is unhealthful. I’m frankly astonished that ever got into print given that the guidelines are published by the US Department of Agriculture (jointly with HHS), even if they did advice replacing full fat with no or low fat dairy. So the evidence must be convincing. Arguing that mainstream nutritional science recognises no and low fat dairy as beneficial, and asking why Dr Greger does not, seems a more difficult question to answer.

          1. Even the Australian dietary guidelines recommend reduced fat dairy – which I also find astonishing given the grip the agricultural sector has on the Australian political system.

            You really are out on a limb in your belief that (all) dairy is healthful. By comparison, Greger is much more mainstream since both the US and Australian dietary guidelines tell us to avoid full fat dairy and they also accept that reduced fat ‘dairy alternatives’ are acceptable and healthful.

    1. Yes, I have seen studies that zinc blocks corona virus replication at least in petri dishes eg
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2973827/

      And that the virus initially replicates in the throat ….. so people are suggesting sucking on zinc lozenges Unfortunately they are unobtainable where I am. Note also that the US Office of Dietary Supplements states

      ‘Zinc toxicity can occur in both acute and chronic forms. Acute adverse effects of high zinc intake include nausea, vomiting, loss of appetite, abdominal cramps, diarrhea, and headaches [2]. One case report cited severe nausea and vomiting within 30 minutes of ingesting 4 g of zinc gluconate (570 mg elemental zinc) [84]. Intakes of 150–450 mg of zinc per day have been associated with such chronic effects as low copper status, altered iron function, reduced immune function, and reduced levels of high-density lipoproteins [85]. Reductions in a copper-containing enzyme, a marker of copper status, have been reported with even moderately high zinc intakes of approximately 60 mg/day for up to 10 weeks [2]. The doses of zinc used in the AREDS study (80 mg per day of zinc in the form of zinc oxide for 6.3 years, on average) have been associated with a significant increase in hospitalizations for genitourinary causes, raising the possibility that chronically high intakes of zinc adversely affect some aspects of urinary physiology [86].

      The FNB has established ULs for zinc (Table 3). Long-term intakes above the UL increase the risk of adverse health effects [2]. The ULs do not apply to individuals receiving zinc for medical treatment, but such individuals should be under the care of a physician who monitors them for adverse health effects.’

      The upper limit for zinc intake (from all sources) is 40mg per day for adults
      https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/

      1. Thanks, Tom.

        That is good to know. I am not taking high doses. Just some and it won’t be for years. It will be for weeks.

        I heard from my friend who has not set foot outside of his restaurant in Paris. He is so traumatized. Worse than I am. Going to work every day has kept some degree of normalcy for me. I don’t have a sense of claustrophobia.

        I told him that he has to watch Herman’s House – if that man kept his friendly personality after 40 years in solitary confinement in a room basically the size of a parking space, we can manage a few months of this. (But I haven’t been locked anywhere, so that is coming from the voice of a freedom-loving hypocrite.)

        People are going to need counseling after all of this.

        He isn’t going hungry anyway and he has a pretty nice sized space to be in, but the sense of thousands of people dying on the other side of the door is overwhelming. It would be a hard time to live in a city.

  6. Hello, I tried to find a direct email to use but posting here. My understanding is that the way to contact with a question is leaving a comment? Sorry if I overlooked information on doing that.

    I registered to listen to the webinar on Surviving a Pandemic but was unable to attend. There was reference to receiving a recording? I looked for information on the recording but haven’t found it? Can someone let me know more details? I really want to hear this presentation. thank you.

    1. Hello,

      Thank you for your comment and interest. The webinar unfortunately won’t be made publicly available, but we do have a blog post coming up this week with the key takeaways and we’ll also have two live Q&As on Thursday with Dr. Greger. We’ll also be announcing a new pandemic-based webinar for May very soon.

  7. That sounds like LADA. This person should be under care of a diabetologist. It would be helpful if this doctor is familiar with the clinical research supporting a whole food plant based diet, as this patient can have both lack of insulin production (which is what you described) as well as insulin resistance (Type II diabetes) if they do not eat properly.

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