8/15/2016

Health Secrets of the Amish - The New York Times

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The Opinion Pages

CONTRIBUTING OP-ED WRITER

Health Secrets of the Amish

Moises Velasquez-Manoff

AUG. 3, 2016

In recent decades, the prevalence of asthma and allergies has increased between
two- and threefold in the United States. These days, one in 12 kids has asthma. More
are allergic.
The uptick is often said to have started in the late 20th century. But the first
hint of a population-wide affliction the sneezing masses came earlier, in the late
19th century, among the American and British upper classes. Hay fever so closely
hewed to class lines, in fact, it was seen as a mark of civilization and refinement.
Observers noted that farmers the people who most often came in contact with
pollens and animal dander were the ones least likely to sneeze and wheeze.
This phenomenon was rediscovered in the 1990s in Switzerland. Children who
grew up on small farms were between one-half and one-third less likely to have hay
fever and asthma, compared with non-farming children living in the same rural
areas. European scientists identified livestock, particularly dairy cows, fermented
feed and raw milk consumption as protective in what they eventually called the
farm effect. Many scientists argued that the abundant microbes of the cowshed
stimulated childrens immune systems in a way that prevented allergic disease.
Then, a few years ago, researchers found an American example of the
phenomenon: the Amish. Children from an Amish community in Indiana had an
even lower prevalence of allergies than European farmers, making them among the
least allergic subgroup ever measured in the developed world.

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Health Secrets of the Amish - The New York Times

Now a study released on Wednesday in The New England Journal of Medicine

advances the research. The authors did something new and important: They found a
suitable comparison group for the Amish in another farming community, the
Hutterites. The two groups share genetic ancestry. Both descend from Germanspeaking stock. But unlike the Amish, the Hutterites, who live in the upper Midwest,
are as allergic as your average American.
Why doesnt farming protect the Hutterites?
A likely reason is that while the Amish have small farms, with cowsheds located
right next to their homes, the communal-living Hutterites house their livestock miles
away. The Amish probably bring more microbes into their homes and some may
waft in directly resulting in a microbial load nearly six times higher than that
found in Hutterite houses, the scientists discovered.
In addition, primarily adult men work with the cows in Hutterite communities,
while Amish children play in the cowsheds, and Amish women, including pregnant
ones, presumably have frequent contact with the cowshed microbes. In Europe,
women exposed to these microbes while pregnant have been found to have the least
allergic kids of all. Microbial stimulation of the maternal immune system may
preprogram the unborn child against allergy an effect thats reproducible in
rodents. So while both communities farm, the Hutterites seem to lack the right
exposures at the right time.
About 5 percent of the Amish children in the study have asthma, while 21
percent of the Hutterites do. And the immune systems of these two genetically
similar communities look remarkably different. Hutterite children have more white
blood cells involved in allergy, called eosinophils, while another cell type, called
neutrophils which specializes in repelling microbes predominates in Amish
children. Perhaps more important, Amish white blood cells have a different profile
of gene expression than Hutterite, one that signals restraint rather than aggression.
This ability to not overreact to pollens and danders is, scientists think, important for
avoiding asthma and allergies.
The scientists also sought to reproduce these immunological profiles in animals
by treating mice with microbe-laden dust from both Amish and Hutterite homes.

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Health Secrets of the Amish - The New York Times

The two dusts had drastically different effects when the mice inhaled them through
their noses every few days for over a month. Amish dust prevented symptoms of
asthma; Hutterite dust encouraged them.
Broadly speaking, the immune system has two arms: the adaptive immune
system, which learns and remembers; and the innate immune system, which
operates like a sensory organ, recognizing ancient patterns in the microbial world.
When the scientists genetically hobbled the animals innate immune systems, the
Amish dust lost its protective effect, and the animals began to have trouble
breathing. The implication is that stimulation of the innate immune system is critical
to preventing asthma.
The study has some shortcomings. Its small just 30 children from each
community. The scientists didnt identify the specific microbes that might be
important. Nor do they know if those microbes take up residence in the gut
microbiome or elsewhere in the body. Martin Blaser, director of the Human
Microbiome Program at New York University, also points out that the scientists
didnt control for antibiotic use or C-section rate, both of which may, by disturbing
the gut microbiota, alter asthma risk.
But the fact that they could so faithfully reproduce in mice what they saw in
people using only dust suggests that theyve identified an important component of
the farm effect. And the simplicity of the mechanism microbes that stimulate the
innate immune system is heartening. That is precisely why were so excited,
Donata Vercelli, a researcher at the University of Arizona in Tucson and a senior
author on the study, told me. This seems to be a manageable situation, she said,
one that could lead to a plausible intervention, like a preventive medication based on
Amish microbes.
The findings also reiterate the theme that genes arent destiny. Disease emerges
from the dance between genes and environment. The asthma epidemic may stem, at
least in part, from the decline of what Graham Rook, an immunologist at University
College London, years ago called our old friends the organisms our immune
systems expect to be present in the environment. The newly sneezing upper classes
in the 19th century may have been the first to find themselves without these old

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Health Secrets of the Amish - The New York Times

friends. Now most of the developed world has lost them. The task at hand is to figure
out how to get them back. One answer may come from the Amish cowshed.
Moises Velasquez-Manoff, the author of An Epidemic of Absence: A New Way of
Understanding Allergies and Autoimmune Disease, is a contributing opinion writer.
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