The Gut and Autoimmune Disease
"All disease begins in the gut." — Hippocrates, approx 400 BC
Do you experience joint pain, brain fog, gut symptoms, depression or fatigue? Have you gained a significant amount of weight without any real explanation? These are some of the earliest symptoms of autoimmunity and often a person can go a lifetime experiencing these without receiving a proper diagnosis of a disease.
What is Autoimmune Disease?
Autoimmune disease is where your immune system mistakenly attacks your own body’s tissues and organs. Normally, when a virus or bacterial infection begins to invade the body, your body’s immune response is to produce antibodies that work against these harmful microorganisms. But with autoimmunity, the body creates autoantibodies that end up attacking the cells they’re meant to protect.1
So here you are, feeling really off and out of sorts and for years you have been plodding along, pushing through each day. Everyone else around you keeps saying, “you’re fine, it’s just stress” however, you know within yourself that something is wrong. You get all these blood tests done but nothing looks too concerning and you are told to just lose weight, get more sleep and reduce your stress. Your doctor even prescribes you anti-anxiety medication to help calm you down. And you’re left with little to no answers and no way of knowing how to get better.
With autoimmunity, people often forget that it occurs on a spectrum. It is progressive and develops slowly, almost imperceptibly, over time. It’s like a tiger creeping up on its prey- stealthy and discreet. It’s not like you wake up with diabetes or Alzheimer’s one morning- often they progress over years, sometimes decades. In fact, research has shown that for autoimmune diseases, including diabetes and Alzheimer’s, the process starts as early as our twenties and thirties, with multiple steps of declining health along the way. Unfortunately, a medical diagnosis can only really occur after there is significant tissue damage and by then, it is very hard to reverse and sometimes, even to manage.
The Three Pillars of Autoimmune Disease
There are more than 80 different types of autoimmune diseases.2 There are three essential components or pillars that must be present in order for someone to develop an autoimmune disease:
- 1. Genetic predisposition
Certain genes make individuals more likely to develop an autoimmune disease. If you have an autoimmune disease, there is a high percentage that someone else in your family also carries the gene.
- 2. A trigger
A specific antigen, or protein that the immune system marks as a threat (real or not) which sets off an inflammatory cascade. This is the straw that breaks the camel’s back so to speak. This could include offending foods, moulds, pesticides, preservatives or additives. In the case of Coeliac disease, the trigger is gluten however, for a lot of autoimmune diseases, the trigger is unknown.
- 3. Leaky gut
This is where your normally tightly knit cells of the intestines become porous, allowing large compounds such as proteins from food or bacteria to enter your blood stream. Your immune system then marks all the toxins, microbes and food particles, such as gluten, that are now flooding through the porous intestinal wall and into your bloodstream as “dangerous invaders.” This creates a perfect storm as the immune system incites an inflammatory cascade in order to rid the body of these “invaders.” It sends wave after wave of indiscriminate attacks, destroying your own healthy cells and body’s own tissues in the process, leading to autoimmune disease. Leaving leaky gut untreated can cause your condition to progress, putting you at higher risk of developing autoimmune disease.3
Your Gut Microbiome and Autoimmunity
In the last 10 years, the microbiome has begun to be recognised as an essential factor in overall health and a key player in autoimmune disease. It is critical for more than just digesting food- it is linked to manufacturing vitamins, regulating metabolism and blood sugar and influencing both genetic expression and brain chemistry. The microbiome is also a primary component of the immune system as 70% resides within the gut. It is the controller of how the immune system operates and is the initial part of your arsenal to control offending invaders.
Your microbiome is like a garden. When it is not properly nurtured and cared for, harmful bacteria and fungi take over. This can send the immune system into overdrive, firing off a cascade of inflammatory chemicals that cause you to develop chronic inflammation, and in time, an autoimmune disease. When blood tests identify that you are on the autoimmune spectrum, it indicates a catastrophic failure of the microbiome allowing too many pathogenic bacteria, the bad guys, which activate genes for inflammation, leaky gut and autoimmunity.4
Gluten and its Role in Autoimmune Disease
Gluten is a protein naturally found in certain grains and is now found almost everywhere. It is found in flour-based foods such as pasta and bread and it is also used as a filler in both supplements and medications. Scientists have also been able to denature gluten, allowing it to be dissolved into liquids and other products such as meat and even shampoo! As a result we are being exposed to even greater amounts of it!
When you consume gluten, it travels through your stomach to your small intestine where it triggers the release of zonulin. Zonulin is a protein that signals the tight junctions of your intestinal wall to become porous, leading to leaky gut which we already know is a predisposing factor for autoimmune disease.5
Gluten also poses a serious risk for those with autoimmune disease because of a phenomenon known as molecular mimicry. Every time your body is exposed to an invader (in this case gluten), your immune system memorizes its structure so that it can recognise it in the future and develop an adequate defence to it. However, gluten happens to be structurally similar to a number of your own body’s tissues. The immune system then registers it as an invader and attacks your own tissue.
For example, in those with autoimmune thyroid disease, every time they eat gluten, the immune system sends out antibodies to detect and destroy the gluten. Since the gluten and thyroid gland are structurally very similar, some of those immune cells end up attacking the thyroid by mistake. Casein in dairy also has a similar molecular structure to gluten and can trigger the same immune reaction.
How to Treat your Autoimmune Disease from a Gut Perspective
Your doctor may tell you there is not much you can do to manage your autoimmune disease except by popping some pills. However, the foods you eat can make a remarkable difference in the frequency and severity of autoimmune flare-ups and can help you get back to feeling your best self. Here are some of the first steps you should take:6
- 1. Avoid Gluten Completely
The best thing you can do if you have an autoimmune disease is to completely remove gluten from your diet as soon as possible. Even if you have less than 1/8 thumbnail of gluten, it has the ability to activate the inflammatory cascade which will last for 2-6 months! So even if you only ate gluten four times per year, you would be in a state of chronic inflammation year-round!
- 2. Follow an Anti-Inflammatory Diet
Inflammation is strongly linked to not only autoimmune disease flare-ups but also to their development in the first place. Excessive animal protein, simple sugars, gluten, dairy and food additives/chemicals increases inflammation and can imbalance immunity. Soy products are also highly inflammatory for some people so are best to avoid. They are also often genetically modified and soy is known as a common food irritant. Focus instead on organic fruits and vegetables, adequate clean proteins like legumes, nuts and seeds and foods high in essential fatty acids such as olives, avocados, nuts and seeds. Try not to overeat and chew your food properly to make sure you’re completely digesting your food and thus avoiding unfavourable bacterial growth.
- 3. Take a high quality probiotic
It’s important to repopulate your gut with good bacteria so taking probiotics in both food and supplement form is recommended. Probiotic foods include kombucha, kefir, sauerkraut, kimchi and coconut yoghurt.
- 4. Vitamin D
Scientists have linked critically low vitamin D levels with autoimmune diseases like Lupus and Multiple Sclerosis. Vitamin D is well-known for its role in regulating the immune response. Getting at least 20 minutes of sunlight on your skin provides the most bioavailable form of your daily dose of vitamin D. You could also look at supplementation.
- 5. Reduce your environmental toxin exposure
Both exposure to environmental toxins (such as pollution, heavy metals, pesticides and recreational drugs) as well as toxins produced by the bacteria within your gut can activate the immune system and cause inflammation. Buying organic foods as much as possible, drinking tap water and purchasing only natural household cleaning products as well as cosmetics are some of the first steps you can do to decrease your exposure.
- 6. Exercise
Exercise is shown to regulate and strengthen immune health. Aim to do moderate intensity exercise for at least 40 minutes per session, 4 times per week.
- 7. Manage stress and anxiety
As stress causes inflammation in the body and dampens the immune system, it is important to incorporate some things into your daily routine to alleviate its impact. This could include going for a walk, yoga, journaling, exercising or taking a relaxing bath.
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1 O’Bryan, T. (2016). The Autoimmune Fix: How to Stop the Hidden Autoimmune Damage that Keeps You Sick, fat and Tired Before it Turns into Disease. Rodale Books, New York.
2 National Institute of Environmental Health Sciences. (2020). AutoImmune Diseases. Retrieved from https://www.niehs.nih.gov/health/topics/conditions/autoimmune/index.cfm
3 Mu, Q., Kirby, J., Reilly, C. M., & Luo, X. M. (2017). Leaky Gut As a Danger Signal for Autoimmune Diseases. Frontiers in immunology, 8, 598. https://doi.org/10.3389/fimmu.2017.00598
4 Khan, M. F. & Wang, H. (2020). Environmental Exposures and Autoimmune Diseases: Contribution of Gut Microbiome, Front. Immunol, https://doi.org/10.3389/fimmu.2019.03094
5 Fasano A. (2012). Zonulin, regulation of tight junctions, and autoimmune diseases. Annals of the New York Academy of Sciences, 1258(1), 25–33. https://doi.org/10.1111/j.1749-6632.2012.06538.x
6 O’Bryan, T. (2016). The Autoimmune Fix: How to Stop the Hidden Autoimmune Damage that Keeps You Sick, fat and Tired Before it Turns into Disease. Rodale Books, New York.
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