I recently came across a valuable book, Dr. Michael T. Murray's Natural Alternatives to Over-the-Counter and Prescription Drugs (William Morrow & Co., Inc., 1994). Murray, a naturopathic physician, gives lucid explanations of how certain drug therapies work, from headache and heartburn remedies to anti-hypertensive and cholesterol-lowering drugs. He even has a chapter on corticosteroids, which IgAN patients commonly know as prednisone, the most frequently prescribed oral corticosteroid.

Prednisone works by blocking "key steps in the allergic and inflammatory response, including the production and secretion of the so-called inflammatory mediators such as histamine, prostaglandins, and leukotrienes by white blood cells." As Murray points out, disrupting the normal defense reaction of white cells stops the inflammatory response, but "essentially cripples the immune system."

Long-term use of prednisone has many side-effects. At doses higher than 10 mg per day, some of the common side effects of long-term use are depression and other mental or emotional disturbances, high blood pressure, diabetes, peptic ulcers, acne, excessive facial hair in women, insomnia, muscle cramps and muscle weakness, thinning and weakening of the skin, osteoporosis, and increased susceptibility to blood clot formation. Since long-term use also suppresses the adrenal glands' production of natural corticosteroids, discontinuing the drug suddenly can result in collapse and even death.

According to Murray, "virtually every condition treated with corticosteroids has responded to a diet that has eliminated food allergies." Murray cites studies done on patients with Crohn's disease, ulcerative colitics, rheumatoid arthritis, asthma, and eczema, all disorders commonly treated with corticosteroids of various types.

While Murray does not refer to IgAN, there have been studies showing some success with a gluten-free diet in treating IgAN. Not all patients are allergic to wheat gluten; but in some areas, Ireland being one, IgAN commonly is secondary to another disease, namely, celiac sprue, which involves an absolute intolerance to gluten. Cow's milk is another food that is highly allergenic (which is one reason IgAN patients should consider going off all dairy products for a six-month period to see if it helps).

A recent Italian study reported that all but one of a dozen IgAN patients with heavy proteinuria had their protein loss markedly reduced (or even disappear) while on a low-antigen diet (that is, one that is virtually free of allergenic foods). Perhaps even more important, subsequent biopsies showed that the deposits of IgA in patients' mesangial tissues was "significantly reduced," along with a reduction in fibrinogen and complement C5.

Many of our patients report having allergies of various types, and some have developed allergies after developing IgAN. Food allergies are somewhat difficult to trace, however, for you don't necessarily have an immediate reaction to what you're eating. A delayed reaction is quite possible. Sometimes, too, people actually crave the very foods to which they are allergic. And some foods known to be highly allergenic, such as corn, are difficult to eliminate from the diet because they're everywhere.

There are laboratory tests for food allergies. Serammune Labs in Reston, Virginia, performs an ELISA/ACT that tests a single blood sample for reactions to 235 substances, including oils, sugars, additives, preservatives, certain pesticides and chemical compounds as well as foodstuffs. The test is very expensive, and not all health insurance may cover it. But it is useful for identifying delayed hypersensitivity.

A cheaper way of doing this is to use an elimination diet, for which Murray's book gives instructions. After a person has been off all allergenic foods for a period, they are rotated back into the diet, one at a time, to see what reaction, if any, develops. One problem with this method, however, is that it is slow and does not account for confounding factors, such as food coloring, or preservatives, or flavoring agents, or other chemicals.

In addition to eliminating food allergies, Murray suggests following a vegetarian diet, because the essential fatty acids found in vegetable oils contribute to the formation of prostaglandins that inhibit inflammation. Fruits and vegetables are also rich sources of such anti-oxidant compounds as beta-carotene, bioflavonaoids, vitamins C and E, selenium, and sulfur-containing amino acids, which are needed to protect the body from the tremendous increase in free radicals that takes place during an inflammatory process.

Murray also notes that pancreatin [proteolytic enzymes isolated from fresh hog pancreas] and bromelain [the protein-digesting enzyme of pineapple] have been shown to be effective anti-inflammatory agents. Pancreatin has reduced levels of circulating immune complexes, with a corresponding clinical improvement in many cases; bromelain appears to inhibit the formation of pro-inflammatory compounds and block the production of kinins, compounds that increase swelling.

A third natural anti-inflammatory agent, curcumin (the yellow pigment of the spice turmeric), shows anti-inflammatory effects similar to, though weaker than, cortisone's, but without the toxic side effects, according to Murray. This triggered a memory in me: one of the treatments used successfully on my son was an extract of khella/turmeric prepared by Herb Pharm in Williams, Oregon. Now I understand why.

1. Dr. Michael T. Murray, Natural Alternatives to Over-the-Counter and Prescription Drugs (New York: William Morrow & Co., Inc.), 155.

2. Ibid., 156.

3. Ibid., 157.

4. C Ferri, et al., "Low-Antigen-Content Diet in the Treatment of Patients with IgA Nephropathy," Nephrology, Dialysis, Transplantation, v. 8 (11) (1993), 1193-8.

[Reprinted from Network News, No. 6 (April, 1996)]