Gut microbiome links to autoimmune disease

Photo Cred: Nadine Primeau/Unsplash

By Kellie Blake, RDN, LD, IFNCP

I have personally struggled with an autoimmune disease for most of my life, so I completely understand the frustration many of my patients with autoimmune symptoms feel. It’s common for these patients to endure years of medical appointments and harsh medications before receiving a diagnosis. Then, despite their symptoms finally having a name, there is often no effective treatment presented for healing.

The National Institutes of Health (NIH) estimates more than 24 million Americans suffer from various autoimmune disorders with another eight million carrying auto-antibodies. Women are more often affected than men and these diseases seem to be on the rise. There are now over 100 identified autoimmune diseases with autoimmune thyroid disease and type 1 diabetes being the most common.

Autoimmune disease results when the innate immune system can no longer distinguish friend from foe. Instead of attacking potentially harmful viruses, bacteria, and parasites, the body begins to see its own tissues and organs as foreign. As a result, patients experience a wide variety of symptoms, some with serious consequences.  

It seems like a hopeless battle at times and many patients wonder how on earth they can keep their bodies from being in this attack mode. To better help our patients reverse their autoimmune symptoms as integrative providers, we need to first understand how a patient’s autoimmune process developed.

There is a strong genetic component to most autoimmune diseases and an environmental trigger. But these two factors alone are not enough to create the full expression of autoimmune disease. In fact, only ten percent of those with a genetic predisposition for autoimmune disease go on to develop clinical disease. Alessio Fasano, MD and his colleagues have described a third necessary component, increased intestinal permeability.

The epithelial cells of the small intestine are connected by a series of tight junctions and desmosomes, which were originally considered to be static and impermeable to large molecules. However, we now understand these tight junctions are active and susceptible to modification through a complex regulatory system. The zonulin family of proteins help to regulate the permeability of the gastrointestinal barrier to maintain homeostasis within the body, but also with the outside environment. When there is an inappropriate release of zonulin, though, a loss of barrier function occurs. The innate immune system is triggered, and a release of pro-inflammatory cytokines occurs allowing for an even further, sustained increase in intestinal permeability. When this cycle continues unchecked, clinical disease develops.

Gliadin is the specific trigger for zonulin release in those with celiac disease and type 1 diabetes, but an imbalanced gut microbiome and dysbiosis are thought to also cause inappropriate zonulin release in those with chronic inflammatory diseases.

As reported in the BMJ, the gut microbiome of patients with autoimmune disease is altered when compared to healthy controls and the dysbiosis that is present is partially responsible for the development of clinical disease. For example, in inflammatory bowel disease (IBD), there is lower overall gut microbiome biodiversity, increased Bacteroides and decreased Firmicutes. There is also a decrease in short-chain fatty acid (SCFA) producing bacteria and an increase in pathobionts, which alters immune function, creates inflammation, and ultimately leads to the full expression of the disease.

In the case of rheumatoid arthritis (RA), patients have increased numbers of Prevotella copri and diminished numbers of Bacteroides. In those with multiple sclerosis (MS), there are reduced numbers of Bacteroides, Faecalibacterium, Prevotella, Butyricimonas, and Collinsella, but increased amounts of Bifidobaterium, Streptococcus, Methanobrevibacter, and Akkermansia muciniphila. In Lupus, there is a decreased Firmicutes/Bacteroidetes ratio.

By targeting the gut microbiome with nutrition and lifestyle-related strategies, integrative providers can assist patients with autoimmune conditions that seemingly have no effective conventional treatment. Personalized nutrition changes always lead to improved quality of life and can reverse the disease process.

Case Study

Tonya is a 45-year-old female who sought nutrition counseling for a new diagnosis of systemic lupus erythematosus (SLE). She is five-foot four inches tall and initially weighed 178 pounds. She was not following any certain meal plan but was eating three meals and three snacks per day with frequent fast-food intake. Her water intake was poor and due to her pain and significant lupus rash, she was not exercising. She reported a long history of migraines and skin issues and had recently been experiencing joint and muscle aches and stated she felt exhausted all day. Her sleep was poor, and she felt excess stress related to her health and family matters.

This patient was initially taking two anti-depressants, vitamin D3, omega-3, chewable calcium, and magnesium citrate. Her initial symptom score of 113 indicated severe symptoms.

The initial plan for Tonya included:

1. A full elimination diet for a minimum of four weeks to support gut healing and uncover food sensitivities.
2. 80 ounces of filtered water daily.
3. A 10-minute walk after each meal for suspected insulin resistance.
4. Daily meditation of three to five minutes to support a healthy stress response.
5. Creation of a healthy sleep routine.
6. Nutritional supplements including a probiotic with 100 million CFU Lactobacillus salivarius UCC118 to target small intestinal tight junctions; N-Acetyl Cysteine (NAC) – 500 milligrams per day as a precursor to glutathione to target immune system function and detoxification; Cruciferous vegetable extract to support detoxification and estrogen balance; L-glutamine powder, three to five grams per day to help heal the gut lining and fuel enterocytes; and EPA/DHA 2,000 milligrams per day to address inflammation and depression.
7. Suggested lab work including full thyroid panel including antibodies, vitamin D, celiac panel, homocysteine, folate, fasting insulin, and iron panel.

After five weeks, Tonya’s symptom score dropped from 113 to 62 and she had lost 20 pounds. She said she felt her overall wellness had improved and her mood was better. While she still felt fatigued, Tonya reported it was more mental fatigue and not the “sluggish, tired, crashing feeling” she felt prior to intervention. In addition, she noticed a huge improvement in her pain and skin issues.

Tonya also reported her headaches had improved and her bowel movements were more regular with a more normal consistency. She was still only drinking about 60 ounces of water per day but had started moving more and planned to add tai chi and strength training to her routine. Sleep was still poor, but she planned to make it more of a priority and she had not yet implemented a meditation practice.

Due to the size of the capsules, Tonya planned to stop the NAC and cruciferous vegetable extract but wanted to continue the other supplements. She was able to have some of the suggested lab work completed but did not have the results available for review.

The follow up plan for Tonya included:

1. A mitochondrial food plan focusing on anti-inflammatory, low-glycemic, and gluten-free foods, low in grains, and moderate in high-quality fats to support mitochondrial function and continue the gut healing process.
2. Discontinue the l-glutamine supplement after eight weeks of use and change the NAC to liposomal glutathione due to difficulty swallowing the NAC capsule.
3. Change to a supplement containing vitamin D3 plus vitamin K2 to support immune function and bone health.
4. Continue all other goals as related to stress management, sleep, and restorative exercise.

When Tonya contacted me, she wasn’t very hopeful about the future. But after making some important lifestyle changes to improve her gut microbiome and support mitochondrial and immune system function, Tonya says she is excited to continue her healing journey. 

References:

Campbell, A. (2014). Autoimmunity and the Gut. Autoimmune Diseases. Retrieved from: https://www.hindawi.com/journals/ad/2014/152428/

Clemente, J. C., Manasson, J., & Scher, J. U. (2018). The role of the gut microbiome in systemic inflammatory disease. BMJ (Clinical research ed.). Retrieved from: https://pubmed.ncbi.nlm.nih.gov/29311119/

Institute for Functional Medicine. Rise of Autoimmune Disease Linked to Intestinal Permeability. Retrieved from: https://www.ifm.org/news-insights/ai-rise-autoimmune-disease-linked-intestinal-permeability/ 

National Institute of Environmental Health Sciences. “Autoimmune Disease” Retrieved from: https://www.niehs.nih.gov/health/topics/conditions/autoimmune/index.cfm