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The Lipid Defense in Autoimmunity - A Case Study
The Lipid Defense in Autoimmunity - A Case Study
Revici Journal
Volume 1, Issue 4 March 2018
The Lipid Defense in Autoimmunity: A Case Study
Lynne August MD
ABSTRACT
A profound degree of lipid peroxidation is seen in systemic lupus
erythematosus (SLE). ¹ Major substrates for lipid peroxidation are
polyunsaturated fatty acids (PUFAs), predominantly arachidonic acid (AA).
AA can be reduced via enzymatic peroxidation to prostaglandins,
leukotrienes, thromboxanes and other inflammatory cyclogenase,
lipoxygenase or cytochrome P‑450 derived products. 2
A case presented here demonstrates use of a lipid panel to evaluate the
degree of lipid peroxidation in SLE. Further, repeat testing after
administration of therapeutic agents indicate the effectiveness of those
agents.
CASE STUDY
Auto Immunity (A.I.) was 18 years of age when brought to me by her
mother in 1992. She has cerebral palsy with accompanying compromises
in cognitive, psychosocial and physical development. Her presenting
complaints were acne and menstrual cramping. AI’s primary sources of
calories were inordinate amounts of orange juice and milk, plus a few
cokes a week.
AI reaped benefits of dietary improvements while taking electrolytes,
mineral and digestive support supplements. But within four years she
returned in a crisis. Starting with Raynaud’s and incapacitating pain in her
hands AI then suffered swelling of joints, generalized aching and soreness,
marked cold intolerance, major weight loss and absence of energy. She
was first diagnosed with Repetitive Stress Injuries from her filing job but
shortly thereafter with SLE.
AI’s rheumatologist started her on Procardia to treat her Raynaud’s but
quickly switched her to hydroxychloroquine (HCQ). Her achiness and
soreness, cold intolerance and joint symptoms improved significantly on
HCQ along with some increase in her energy. However, not until she took
an “anti‑fatty acid” did she fully recover her energy and gain the lost
weight.
INTRODUCTION
Of all the PUFAs, cholesterol has a particularly antagonistic influence on
AA. This occurs via “stearic coupling”. Steric coupling, as described by Dr.
Emanuel Revici, occurs when two molecules are reciprocally attracted
through multiple energetic centers in their nonpolar groups. 3
The energetic centers of cholesterol occur at the hydroxyl group at C3 and
the parallel double bonds between C3 and C4 and C5 and C6. 4
The energetic centers of AA are its carboxyl polar group and four double
bonds with an intermediary positively charged carbon in each pair. 5
Enzymatic conversion of AA to inflammatory eicosanoids occurs at its
energetic centers:
Steric coupling between cholesterol and AA neutralizes AA energetic
centers and prevents the conversion of AA into inflammatory
eicosanoids.
Dr. Revici called cholesterol and lipids that neutralizes the energetic
centers of AA, antifatty acids . Endogenous anti‑fatty acid lipids
additional to cholesterol include cholesterol metabolites, e.g., cortisol and
progesterone. The best known and most frequently used exogenous
anti‑fatty acids are hydrocortisone and prednisone
Lipid peroxides are self‑propagating, which contributes to the profound
degree of lipid peroxidation in SLE and other autoimmune and
inflammatory conditions.
LABORATORY RESULTS
Column A has the average results of select components with ranges from
five blood tests, taken during the first years of consultation.
Column B has the results of these same tests when AI presented with
symptoms almost four years later.
Column C has the results from blood tests after 14 months on HCQ plus
nutritional supplements, Ayurvedic and osteopathic treatments and vision
therapy.
Column D are the results of another 18 months of continued treatment
with HCQ, etc., plus an anti‑fatty acid.
When AI presented with debilitating symptoms in ’98 her globulin had
risen from 3.04 (2.2‑3.2) four years earlier to 4 and her monocytes from
9.6 (0‑10) to 21. The increases in her globulin and monocytes indicate the
extent of autoimmune pathology underway, including a profound degree
of metabolism of AA to inflammatory eicosanoids.
After fourteen months HCQ, and at times up to six extra‑strength Tylenol
(a cyclooxygenase‑2 inhibitor) a day, the overall soreness and achiness in
her body had subsided considerably as did her cold intolerance and the
extreme discolorations of hands and feet. She also continued to improve
her diet, took mineral, electrolyte and glucosamine supplements and
sought osteopathic and Ayurvedic treatments. However, her wrists and
knuckles remained swollen and her weight decreased from 123 at
presentation in ‘98 (height 5’7”) to as low as 105. Thyroid and G.I.
work‑ups were negative except for a positive anti‑gliadin antibody.
The metabolic disturbances in SLE “...showed profoundly dampened
glycolysis, Kreb cycle, fatty acid beta‑oxidation and amino acid
metabolism…” This reduced biogenesis from all sources is primarily the
result of elevated lipid peroxidation products. 1
Antimalarials such as HCQ down regulate the immune response against
autoantigenic peptides by inhibiting Il‑6, IL‑17 and IL‑22 production.
While this mechanism lowered her Sed Rate and appears to have
contributed to her improvements, AI’s high globulin and monocytes did
not decrease. Therefore HCQ did not halt the ongoing profound lipid
peroxidation and did not reverse the weight loss and consequent energy
deficit.
To the contrary, it appears that HCQ actually exacerbated the weight loss.
HCQ significantly reduces total cholesterol (TC) levels by 26.9 mg/dL. 6 This
explains the decrease in AI’s TC from 152 in ‘98 to 122 in ‘99 after seven
months of treatment with HCQ. HCQ also reduces mean LDL‑C levels by
24.4 mg/dL, consistent in AI’s LDL‑C fall of 24 to 66. These decreases in
TC and LDL‑C resulted in a drop of cholesterol in her tissues and cells (TCH)
from 380 at presentation with symptoms to 224 (range 293‑505). It was
only after AI’s TCH dropped significantly that her rapid weight loss
ensued.
TISSUE/CELL CHOLESTEROL (TCH)
TCH is the unbound active cholesterol in tissues and cells. Only unbound
cholesterol couples with AA energetic centers in tissues and cells.
Cholesterol in tissues and cells is an essential endogenous antifatty
acid.
The risk of low cholesterol in tissues and cells is runaway lipid
peroxidation.
The addition of an antifatty acid according to Dr. Revici ⁷ i n late ‘99
immediately and remarkably reversed AI’s weight and energy loss. She
had a robust TCH of 414 after 18 months. After three years of twice‑daily
use AI tapered off the anti‑fatty acid over the next seven years and
remained free of autoimmune symptoms as of 2012 when lost to
follow‑up.
CONCLUSIONS
Dr. Revici’s anti‑fatty acids are organ, glandular, placenta and animal
product extracts of naturally occurring sterols/steroids. Although not yet
commercially available, they offer a promising alternative to
glucocorticoids, most importantly without the attenuated side‑effects of
the latter. Further, while the role of high cholesterol in pathology is well
delineated, the positive effects of anti‑fatty acids in autoimmunity confirm
a role of low cholesterol in pathology. Lastly, monitoring cholesterol in
tissues and cells offers the possibility of a readily accessible test to assess
effectiveness of therapeutic agents.
Copyright (c) 2017 Lynne August MD All Rights Reserved.