Coeliac disease, Rheumatoid Arthritis, Hashimoto’s Thyroiditis, Multiple Sclerosis...these days most of us know someone who has been diagnosed with an autoimmune disease but what does autoimmunity actually mean? And what causes it?
Our immune systems are extremely complex but essentially their main role is to distinguish between ‘self’ and ‘non-self’. In autoimmunity this goes awry - the 'surveillance' arm of the immune system becomes over-reactive. It loses its ability to distinguish 'self' molecules from ‘non-self’ foreign ones which may be harmful & starts to attack the body's own cells/tissues. This can happen anywhere in the body. For example, in autoimmune thyroid disease - called Hashimoto’s Thyroiditis - the immune system starts attacking the thyroid gland and results in symptoms such as inflammation (swelling of the thyroid) and eventually decreased thyroid hormone production which results in decreased metabolism and symptoms such as fatigue, weight gain, depression, thinning hair, brittle nails & constipation. In Multiple Sclerosis it’s the myelin sheaths surrounding our nerve cells and in Rheumatoid Arthritis it’s our joints, mainly in the fingers and wrists.
But what causes the immune system to overreact?
It is generally considered that 3 things are needed for an autoimmune disease to develop:
1. A genetic predisposition
2. An environmental trigger such as stress, toxins, infections (viral, parasitic, bacterial) etc
3. And, potentially, increased intestinal permeability or ‘leaky gut’
70% of your immune system resides in and around your digestive tract. This is because the digestive tract (running from our mouths to the other end!) is the body’s largest interface with the outside world. Everything you ingest needs to be surveyed by the immune system to see whether it may be harmful or not. Most of the time your immune system does not react – it develops ‘tolerance’ to your environment. It simply surveys the scene – constantly sampling the environment – looking out for anything that might harmful to you. The good bacteria in your gut also contribute to the development of tolerance.
However, and this is the crux of the matter, our modern way of life with its constant stress, unhealthy diets and an overwhelming increase in environmental toxins has led to a loss of tolerance. Research is now showing that one of the main ways this is mediated is through increased intestinal permeability or ‘leaky gut’. Our digestive tracts are only one cell thick but these cells are usually very close together in what are called ‘tight junctions’. Stress, unhealthy diets & toxins lead to an increase in the expression of a protein called zonulin which causes these tight junctions to loosen1. Food particles that should be completely digested are allowed to pass through into the bloodstream because the gut has become ‘leaky’ & this causes the immune system to become overwhelmed and subsequently over-reactive.
This link between ‘leaky gut’ and autoimmune disease has been extensively researched in the case of Coeliac disease by the world renowned gastroenterologist & research scientist Dr. Alessio Fasano, chief of Pediatric Gastroenterology and Nutrition at Mass General Hospital in the USA2 and is now being researched as a contributing factor in other autoimmune diseases.
If you suspect you may have an autoimmune condition it is very important that you get a proper medical diagnosis. Visit your GP to talk through your symptoms and concerns.
Looking into whether you have a ‘leaky gut’ may be another supportive measure you can take. Symptoms of a ‘leaky gut’ range from intestinal inflammation and IBS type symptoms such as abdominal pain, bloating, diarrhoea and constipation as well as food allergies and intolerances3 to fatigue and headaches.
Treating a ‘leaky gut’ involves a systematic process known as the 4-R programme (Ibid) which most well-trained integrative healthcare practitioners are familiar with. Firstly, any potential pathogens need to be removed. Secondly, any digestive support which may be compromised such as digestive enzymes, bile and stomach acid need to be replaced. Thirdly, the gut needs to be repopulated with probiotics, prebiotics, fibre and fermented foods to promote the development of tolerance. And fourthly, the gut lining needs to be repaired using healing nutrients such as zinc, an amino acid called L-glutamine, essential fatty acids and vitamin E and incorporating anti-inflammatory ingredients like ginger, turmeric & highly anti-oxidant foods into the diet.
With the correct medication/treatment and plenty of rest & self care, life with an autoimmune disease can be manageable. In fact, it can be wonderful. Being diagnosed with Coeliac disease myself has led me on a journey of learning to look after myself more – paying attention to what my body is telling me it needs – and most of all - treating myself with the loving kindness I look to others to treat me with.
Fasano A, Catassi C (2001) Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. Gastroenterology, 120(3):636-51. [Online] Elsevier (http://www.gastrojournal.org) Accessed: 12th September 2016.
Hollon J, Puppa EL, Greenwald B, Goldberg E, Guerrerio A, Fasano A (2015) Effect of gliadin on permeability of intestinal biopsy explants from celiac disease patients and patients with non-celiac gluten sensitivity. Nutrients, 7(3):1565-76. [Online] Pubmed Central (http://www.ncbi.nlm.nih.gov/pmc) Accessed: 12th September 2016.
Liska D, Bland JS (2010) Digestion and Excretion. In: Jones DS, ed. Textbook of Functional Medicine. Gig Harbor, Institute for Functional Medicine, p189-202.