Comment by hinkley | Hacker News Reader

Comment by hinkley | Hacker News Reader

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Lyme disease talk just makes me think of Nicholas Zakas and then I get bummed out.

I know there's a guy, or maybe he represents a group of researchers, who thinks that Chronic Fatigue Syndrome is caused by inflammation in the brain, either due to some undetectable infection, or just a misfiring that is a lingering effect of some other insult (sounds to me like a histamine response aka allergy).

If your body thought you had the flu but you didn't, you'd be knocked on your ass not unlike many people with CFS or Lyme. And if it never stopped you'd be in pretty bad shape a year in.

So. Are we treating microbes that don't culture in a petri dish, or are we solving an autoimmune response gone whacky? You could really ask the same question about Crohn's or IBS.

I recall years ago reading a long story about a consultant who was called in to figure out why this black soot was all over a neighborhood around a brewery. The brewery said it was diesel exhaust. But why only this neighborhood? He heard of a similar problem is some town in the UK. But Petri dish after Petri dish cultured nothing that could explain the black soot. Ergo, it's not microbial.

Our intrepid consultant pours a small amount of distilled spirits onto a sample dish, and gets a bunch of black shit. The 'soot' was feeding off the Angel's Share (evaporative losses from the brewery), and would barely grow without it. Vigorous growth in vivo, negligible growth in vitro.

We've come up with a cure or treatment for so many microbes that we can detect, but how do we know we're detecting them all? People die of cancer not because cancer is getting worse (well, pollution notwithstanding) but because Cancer is patient. There's a lot of space in the middle for new vectors to slip in.

I think you raise an excellent point, that many don't really think about. Detection is hard, and research on microbes is hard if you can't grow them in-vitro. There is research in this space. A few years ago, I had a lecture from Slava Epstein, a professor who has made some major inroads in this space[0].

[0] https://experiments.springernature.com/articles/10.1038/npro...

I assume you’re aware but I wanted to mention that there are many detection methods besides culture. Electron microscopy, fluorescent DNA probes, histochemistry, etc.

Detection is hard indeed. Here is an interesting research on patients with neurological disabilities though normal imaging (MRI) results, but abnormalities found when inspected using diffuse tensor imaging: https://nn.neurology.org/content/5/3/e456

I really enjoy your writing style. Flows extremely well.

Thank you for this comment. It prompted me to look into Nicholas Zakas and his story. I've decided to make my way to a Lyme disease specialist based what his information lead me to think about co-infection.

Keep writing! HN needs more thoughtful comments like yours.

Don't Crohn's and IBS nigh disappear when using CBD heavy Cannabis? Pointing towards a combination of inflammation and stress.

Ibuprofen doesn't make the flu go away, but it protects you from having a seizure from high fever.

I have Crohns, and want to expand on what Hinkley is alluding to. Some drugs modify the expression of a disease which prevents further damage, and others just mask the issue.

Disease modifiers like methotrexate or stelara will suppress aspects of the immune system, which protects the body from further damage. Ibuprofen on the other hand will mask pain but not modify the underlying issue.

If CBD was effective (for me it doesn't seem to be), then the challenge is in understanding if it is modifying the disease, or just hiding symptoms like ibuprofen would for pain.

Thank you for your perspective. I did understand the point made by Hinkley. May I ask, did you use CBD only or THC with CBD? I've only known it to be effective with both.

I thought the understanding is CFS is a physical manifestation of depression.

Great writing.

Thanks. I can be hit or miss. Maybe I need an editor :)

Sometimes I read old stuff and think, "wow, I said that?" other times, "I have no idea what point I was trying to make."

Smart talking aside it's possible and relatively easy to identify microbes without growing them. When an immuno-suppresive is effective at reducing symptoms you know it's an autoimmune disorder. You can even find specific anti-bodies in some cases.

>You could really ask the same question about Crohn's or IBS.

No you couldn't. They are clearly auto-immune disorders.

Out of curiosity, do you have any formal training on medicine/physiology or is your knowledge base self-aquired?

> When an immuno-suppresive is effective at reducing symptoms you know it's an autoimmune disorder.

Aren't there diseases where someone are caused not by the microbe directly but by the body's immune reaction to it?

> Out of curiosity, do you have any formal training on medicine/physiology or is your knowledge base self-aquired?

Argument from authority (or lack thereof) is pretty contrary to the HN ethos, imo. You're not right because your degree says so, but because the facts do.

>Aren't there diseases where someone are caused not by the microbe directly but by the body's immune reaction to it?

There are symptoms that can be caused by that. The characteristic of an autoimmune disorder is that the response never ends( either chronic or with flare ups) or takes way longer than a normal one would.

> Argument from authority (or lack thereof) is pretty contrary to the HN ethos, imo. You're not right because your degree says so, but because the facts do.

What facts did you state then? I'm asking where does your thinking process stems from?

> Aren't there diseases where someone are caused not by the microbe directly but by the body's immune reaction to it?

Yep. For example, that's what causes the "cytokine storm" in COVID-19.

There is a growing consensus in immunology/rheumatology that infections may be a major cause of autoimmunity. One mechanism is molecular mimicry - antigens from foreign invaders that are similar to your body’s own proteins trigger your immune system to attack both self and invader.

https://www.nejm.org/doi/full/10.1056/NEJM199912303412707

Why is the auto-immune response chronic, if say the original infection passes? Or is the infection constant as well?

Viruses typically invade a cell by latching onto a part of the cell membrane, usually a receptor of some sort. Those receptors are for some biologic process from regulation to nutrition. If it can't mimic any structure it can't reproduce and will be selected out.

An antibody is in some ways similar. They latch onto the bacteria or virus, but instead of invading they glom on and then signal the body to come dispose of this thing.

If your body picks the wrong feature for the pattern, then the antibody could attach to healthy tissue. Maybe one particular type, like insulin cells, or myelin.

Your comment appears incredibly arrogant to me. Trivializing detection of auto-immune disorders tells me immediately you have no experience in the field, or if you do you are theory-heavy and practice-light.

My daughter has an auto-immune disorder and it took two years and a brain biopsy for the best pediatricians in Canada to determine it was auto-immune related. Of course you may dismiss that by saying there are no good doctors in Canada because they're not from (wherever you're from), but your casual dismissal of the complexity of these disorders is simply wrong.

And your last sentence is clearly not just "out of curiosity".

IBS is "clearly not" as it is a diagnosis based more on symptoms (many different) and there is no clear understanding of the cause behind it.

And if you look at IBD such as Crohn's or Ulcerative Colitis then sure.

> Out of curiosity, do you have any formal training on medicine/physiology or is your knowledge base self-aquired?

This isn’t an argument that supports your reasoning. It’s just an appeal to authority.

> When an immuno-suppressive is effective at reducing symptoms you know it’s an autoimmune disorder.

Is surgery an autoimmune disorder? A lot of doctors will give a patient steroids to reduce inflammation after surgery.

This seems to ignore the diseases we don't understand, that don't fit clearly those criteria, like PSC.

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