The million dollar question is why does autoimmunity happen to some people and not others? We are coming much closer to an understanding of how and why autoimmunity happens and who is at risk.
The First Reason: Leaky Gut, Dysbiosis and the Microbiome
Leaky Gut Syndrome has become a common term that is used to describe a condition where the lining of the intestinal tract has become porous, allowing large food particles entry into the blood stream causing immunological reactions. Leaky gut is now believed to be the most basic cause of allergies and asthma as well as many autoimmune conditions. It is also associated with autism and is the focus for the emergence of current research.
Dysbiosis refers to a gut that has an imbalance in the microbiome. It is becoming more and more apparent that diversity is the key to a healthy microbiome in the gut.
The Hygiene Hypothesis postulates that we are so clean that we have killed off some of the beneficial commensal parasites such as helminthes that have evolved within our bodies and help to damp down the immune response. They add to the diversity of microorganisms in the gut.
Fecal Microbial Transplantation is also an emerging therapy for autoimmunity. The fact that this therapy works for a virulent infection such as C.diff, indicates the power of a healthy microbiome.
Zonulin opens the door to leaky gut
We know that a substance called zonulin opens up the spaces between the cells of the intestinal lining. That normally occurs, in order for nutrient and other molecules to get in and out of the intestine. However, when leaky gut is present, the spaces between the cells open up too much and this allows the larger protein molecules to get into the bloodstream where an immunologic reaction can take place. Once that happens, the body is primed to react to those proteins each and every time they appear.
Zonulin is activated by gliadin
Gliadin is a protein in wheat, that like gluten, is a trigger for people with the autoimmune disease celiac. However, this study published in the Scandiavian Journal of Gastroenterology in 2006 clearly showed that gliadin can affect zonulin even in people without the genetics for celiac. The researchers concluded that,
Based on our results, we concluded that gliadin activates zonulin signaling irrespective of the genetic expression of autoimmunity, leading to increased intestinal permeability to macromolecules.
This is extremely significant because it means that anyone who eats food containing gliadin is at risk for developing leaky gut from this food. What foods contain gliadin?
Grains contain gliadin.
Lectins are manufactured by plants as a way to protect themselves from predators. They are most concentrated in the seed. Here again, soaking sprouting and sourdough may eliminate much of the lectins, but let’s face it — most people eat bread products that have not been properly prepared. Therefore they are at risk for digestive irritation and the resulting leaky gut.
A particularly harsh lectin called wheat germ agglutinin (WGA) is present in our modern day wheat (Triticum aestivum) and is very problematic. It is implicated in many reactions that cause cell death and stimulation of pro-inflammatory cytokines.
The WGA is actually more concentrated in whole wheat because it is located in the bran. It has been found to stimulate antibodies specific to WGA with some ability to cross-react with other proteins.
This organic acid is present in the bran or hulls of all seeds (this includes all grains and nuts as well as soy) and blocks the uptake of critical minerals like phosphorus, calcium, magnesium, iron and zinc. Phytates have been studied extensively and findings show that phytates contribute to widespread mineral deficiencies in third world countries.
Analysis shows that calcium, magnesium, iron and zinc are present in the plant foods eaten in these areas, but the high phytate content of soy and rice based diets prevents their absorption.
Phytic acid also inhibits enzymes that we need to digest our food. These include pepsin, which is needed for the breakdown of proteins in the stomach, and amylase, which is needed for the breakdown of starch into sugar. It also inhibits trypsin, which is needed for protein digestion in the small intestine.
Clearly, eating foods high in phytic acid will reduce your body’s ability to digest and assimilate your food.
The Second Reason: Genetics
Autoimmunity does not have just one gene. Rather, it is a collection of genes that interact with potential environmental triggers. The more of these gene variants you inherit, the greater your chances will be to develop an autoimmune disease.
There are many gene variants that have been identified. An excellent technical discussion of these can be found in Sarah Ballantyne’s book The Paleo Approach.
While genetics do play a role in autoimmunity, which is why we do see it in families, it turns out to account for only one third of the susceptibility. The other two thirds are as indicated – leaky gut (which comes from assaults from the environment) and environmental triggers.
The Third Reason: Environmental Triggers
The Link With Autoimmunity
In February 2012 in the journal, Clinical Reviews in Allergy and Immunology a paper called Leaky gut and autoimmune diseases was published. The author, Alessio Fasano, M.D., had been researching this topic in relationship to celiac disease and gluten sensitivity. The review paper he wrote focused on the role of impaired intestinal barrier function (leaky gut) on autoimmune pathogenesis. In short, he is trying to get to the real causes of autoimmunity.
In this paper, Dr. Fasano proposed a new theory that suggests that autoimmune disease is not only preventable, but also reversible. Amazing!
Fasano’s new theory explains how an autoimmune condition may develop. It involves a perfect storm of three conditions:
- Increased intestinal permeability (leaky gut)
- A genetic predisposition to autoimmunity
- An exposure to the environmental trigger (in the case of celiac disease, it is gluten)
What this means is that people who have a leaky gut, as well as the genetics for celiac disease, can develop autoimmunity when they eat gluten. This will cause intestinal damage. The increased intestinal permeability that is part of the leaky gut, allows the environmental trigger (which in this case is gluten) to access the body and this triggers the genetic predisposition.
Conventional understanding of celiac included variable numbers 2 and 3, but instead of leaky gut, the third variable was the presence of circulating autoantibodies to the enzyme tissue transglutaminase. Using these antibodies excludes many people who do not test positive for them – however, they still have problems with gluten.
Acknowledging that autoantibodies are present does not explain why they are there. Fasano’s theory does explain this. Furthermore, it suggests that if you can cure the leaky gut, you can cure the autoimmune disease.
Other Environmental Triggers
Gluten is not the only trigger. There are many environmental toxins that can trigger autoimmunity. Here are some:
- Chemical exposures – Heavy metals, prescription drugs, pesticides, pollutants such as BPA, occupational hazards and foods that contribute to leaky gut as outlined above
- Infections – While infections may trigger autoimmunity they do not cause it in the same way infectious agents like certain strains of bacteria, viruses and fungi cause a specific disease. It has been postulated that the infection causes antibodies to be formed and these antibodies may recognize certain tissues in the body as the foreign agent. This is called molecular mimicry.
- Persistent Infections – These may exist without symptoms, but are there in the background creating inflammation.
- Hormones – Women are far more likely to suffer from autoimmunity and hormones may be the reason. Women have many opportunities to manipulate their hormones via birth control pills, fertility drugs and estrogen replacement therapy. Additionally there is the monthly fluctuation of hormones with menstruation. This is a very complex issue that is still being understood.
How To Heal From Leaky Gut
The gluten-free diet is conventional treatment for celiac. Some people do very well with this but there is research that shows that only 66% of celiacs fully heal on the gluten-free diet after 5 years. Research also shows that celiacs have a four fold increase in morbidity and mortality. That means that even with a gluten-free diet, celiacs will be sicker and die younger.
It has been postulated that anyone with any autoimmune disease should at least be on a gluten free diet. I certainly agree with this and would add that a grain-free, real foods diet is necessary. These diets include foods that are very easy to digest and assimilate and are full of the nutrients so desperately needed in order to heal and seal the gut. Additionally, they remove foods that interfere with nutrient absorption and healing.
Have you tried either of these diets and if so, what level of success have you had with them? Leave a comment and let me know!
- Celiac Disease: The Perfect Storm
- Leaky Gut: Why It Happens and What To Do About It
- Is Autism an Autoimmune Disorder?