Autoimmune Disease and Gut Health: The Chicken or the Egg?

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I'm gonna be talking about autoimmune disease and how it interacts with gut health issues like SIBO, SIFO, IBS, and leaky gut. But before I get started, if you haven't yet followed or subscribed to the show, be sure to do so. And if you want to get transcripts of the podcast, pop over to my website, deserthealthcoaching.com and sign up for my newsletter. You'll also get my free ebooklet called Finding Your Root Cause Through Stool and Organic Acids Testing when you sign up. If you haven't yet done my quiz on which stool or functional medicine test would help you uncover your root cause, you can find a link in the show notes and take that. Now onto the show. So if you've been listening to the show for a while, you obviously know that we discuss gut health all the time, but autoimmune disease less so. But a little bit. But today I'm really gonna focus on it and start with the basics about autoimmune disease and then get into how it relates to gut health because the two are all tied up together. So first of all, for those who don't know, an autoimmune disease is where your immune system attacks your body's own cells, tissues, and organs. I personally have two autoimmune diseases, which you may have heard me mention on other podcasts, Hashimoto's thyroiditis and post-infectious IBS. The latter is when a protein called vinculin that's involved in the migrating motor complex is being attacked in my small intestine, which creates stagnation in the small intestine and bacterial overgrowth. I did receive a third autoimmune diagnosis in 2013 of something called ITP or idiopathic thrombocytopenia, which is an autoimmune disease impacting your platelets. But a doctor has subsequently told me he doesn't think I ever had it because the diagnostic criteria has changed. And I also was diagnosed at one point with pernicious anemia, which is an autoimmune attack on the parietal cells lining the stomach, which leads to malabsorption of B12. But I've since had negative antibodies there, so I don't consider that a current diagnosis. So if you think of individual autoimmune diseases like Hashimoto's thyroiditis, lupus, or rheumatoid arthritis, you may not think it's all that common. But when you actually add up all of the different autoimmune diseases, it comes to more than 50 million Americans impacted, which is a threefold increase in autoimmunity over the last 50 years. And interestingly, 78% of those impacted by autoimmunity are women. So other than the diseases I just mentioned, some of the other most common autoimmune diseases are celiac disease, Graves' disease, type 1 diabetes, vitiligo, scleroderma, psoriasis, inflammatory bowel disease, Addison's disease, and Sjögren's. But there are more than 100 autoimmune diseases that are either systemic or attack individual organs. Based on twin studies, about 25% of autoimmune disease can be attributed to genetic causes versus 75% environmental causes. But in reality, it's always a combination of genetic and environmental factors that leads to the manifestation of an autoimmune disease. So thanks to the work of Dr. Alessio Fasano, a world-renowned gastroenterologist and gluten intolerance expert who is chief of pediatric Gastroenterology and Nutrition at Mass General Hospital for Children and director of the Center for Celiac Research and Treatment, we know that there are 3 necessary precursors to autoimmunity: a genetic predisposition, an exposure to a trigger such as trauma, stress, toxins, the use of certain medications, or exposure to an antigen, and— and listen closely because this is the important part— intestinal permeability or leaky gut. So in summary, you need a genetic predisposition, a trigger, and a leaky gut. Now, before I delve deep into gut-related infections and triggers, let me just mention the other autoimmune triggers. So in terms of antigens, which are toxins or other foreign substances which induce an immune response in the body, there are viruses like Epstein-Barr virus, also known as mononucleosis, including having a reactivation of a prior infection, cytomegalovirus, mumps, rubella, herpes simplex virus, and hepatitis C. And then there are toxins that can come from your diet and the environment, including chemicals and heavy metals, which can provoke intestinal permeability and other gut health problems, which we actually discussed in my last podcast. In terms of medication-induced autoimmunity, one of the most common is drug-induced lupus, in which more than 90 medications from more than 10 drug classes have been implicated. And don't just think this is like rare, unusual drugs. There are case reports of drug-induced lupus from drugs as common as statins, antibiotics, PPIs, and NSAIDs, or nonsteroidal anti-inflammatory drugs. And there are even reports of drugs used for other autoimmune diseases called TNF blockers that have induced lupus syndrome. I'll link to the article listing all those drugs in the show notes. Other autoimmune diseases for which drugs have been implicated include RA, polymyositis, dermatomyositis, myasthenia gravis, pemphigus, pemphigoid, membranous glomerulonephritis, autoimmune hepatitis, autoimmune thyroiditis or Hashimoto's, autoimmune hemolytic anemia, Sjögren's syndrome, and scleroderma. But now let's zero in on the relationship between autoimmunity and gut health, starting with the role of leaky gut or intestinal hyperpermeability. So I did a whole episode just on leaky gut on March 17th, 2020, so if you want, you can check that out to go super deep on that topic. But there are several ways in which the gut can become permeable. So first, you can have openings between the cells lining the intestines, or the enterocytes, whose tight junctions hold them together but also allow for them to open up and let nutrients and water through. And when there's dysfunction, they open too wide and for too long. And that's been observed in celiac disease and gluten sensitivity in particular, but can also happen with other food sensitivities. The most common culprits are grains besides wheat or gluten-containing grains, in particular corn, but also pseudo grains, including quinoa, amaranth, buckwheat, and chia, dairy, eggs, nuts, seeds, legumes, in particular soy and peanuts, and nightshades. Which are tomatoes, eggplants, potatoes, and peppers. But I believe that most of the more obscure food sensitivities are usually secondary to a gut infection, dysbiosis, stress, a very poor repetitive diet, or some other cause. Although I have found that gluten, dairy, and nightshades tend to be common primary causes of food sensitivities. You can also have a permeable gut because a substance or infection causes direct damage to the enterocytes, or the cells lining the intestines, which actually creates a hole in the lining of the intestines. This can come from certain foods containing lectins, and there are two potentially harmful subclasses of lectins called prolamins, which are found in grains, legumes, and pseudo grains, including quinoa, rice, peanuts, and soy, and agglutinins found in grains, pseudo grains, and nightshades. And legumes also contain saponins, which is another substance that can harm enterocytes. But keep in mind that even though there may be negatives associated with legumes, meaning beans and lentils, but not including green beans, Overall, they're super healthy foods that are high in fiber, and the lectins and the prolamins and agglutinins found in them can be reduced by soaking, sprouting, and fermenting. They're also deactivated by the heat during prolonged cooking. So if you do need to go off these foods for a time while healing your gut, you should eventually try to reintroduce them if you're cooking them properly. Also, some beans are worse than others, such as soy, peanuts, and kidney beans, and the agglutinins found in them are more resistant to deactivation than others. So if you do have an autoimmune disease, you may wanna steer clear of those ones forever. Or until you're feeling better and your antibodies are normal, and then slowly reintroduce a variety of legumes rather than focusing on just one or two. Two other potential disruptors to proper digestion and mineral absorption that can cause a leaky gut are digestive enzyme inhibitors and phytic acid, or phytates, which are found both in raw nuts and seeds, which is why when you have too many nuts you get that full-bloated sensation. But if you keep it in low quantities, it's fine. But if you really do want to clean up your nuts, you can soak them in salty water and dehydrate them, and I'll link to an article about how to do that. Finally, the more obvious and common culprits of damage to enterocytes in the standard Western diet are alcohol and synthetic food additives. So an autoimmune paleo diet systematically eliminates all of these potentially problematic foods and then reintroduces them slowly so you can test your body's reaction to each of them by category. And while some people may need to eliminate these foods long-term, especially if they are seeing autoimmune symptoms when they're reintroduced, many can be reintroduced, you know, in reasonable quantities in the context of a varied, healthy, whole food diet. Another potential cause of a leaky gut is a gut infection causing damage to your intestinal lining, and this could include parasites like Blastocystis hominis and Giardia, as well as bacteria such as Yersinia enterocolitica, Helicobacter pylori, Klebsiella, Campylobacter, E. coli, and an overgrowth of proteobacteria, as well as Borrelia, which is the bacteria that causes Lyme disease. And gut tests like the GI Map, which I use with many of my clients, reveal many of these types of hidden infections and dysbiosis. And let me just mention that while many healthy people have Blastocystis hominis in their guts, and it doesn't always need to be treated, there are two different types. There's the amoeboid form and the protozoa form. And while the former is associated with chronic hives and adheres to the gut cells more, the latter is not. So that may be one way to distinguish a Blastocystis hominis infection that should be treated versus one that can be left alone. Then there's SIBO, or small intestine bacterial overgrowth. Which can be another cause of leaky gut. And SIBO can happen for a whole slew of reasons, either related to low stomach acid or slow motility in your small intestine. But a prior episode of food poisoning is one common culprit that can lead to post-infectious IBS like I have, where you have elevated vinculin antibodies, which are tested incidentally using the IBS-Smart Test. And when you have post-infectious IBS, you will likely have a lifelong struggle with SIBO, but it is manageable. And of course, invasive candidiasis can also lead to intestinal permeability when the Candida turn into their hyphal form and send tentacles out through the gut epithelium or lining. And note that we all have Candida in our gut, but it can grow out of control due to a poor diet, stress, and certain medications including antibiotics. Speaking of stress, 80% of patients reported serious emotional stress before the onset of their autoimmune disease. So why would that be? Of course, because chronic stress leads to elevated cortisol levels. And this leads to decreased digestive function, lower secretory IgA, which is your gut immune defense cells, and elevated blood sugar. So that opens you up first to gut infections when your gut immunity is decreased, as well as poorly digested food when your digestive functions go down. And then you end up with proteins that are undigested that can trigger autoimmunity when they escape out of the leaky gut because of that gut infection. So that gets us to the mechanism for autoimmunity. So when you have a hyperpermeable gut lining, and especially if you aren't digesting your food well, which can be from the lack of digestive enzymes or lack of hydrochloric acid in your stomach, all from a variety of causes, undigested proteins will escape out into your system and trigger your immune system. And when your immune system is triggered against certain proteins, it can also end up attacking similar proteins in your body, which is especially the case with gluten and Hashimoto's thyroiditis, which I have, because the gliadin protein in gluten resembles the cells in your thyroid gland. And your body gets confused and attacks itself. But studies have shown gluten to be an issue in many autoimmune diseases and in creating intestinal permeability. So if you have any autoimmune disease, gluten is the first thing to eliminate for the long term. Another contributing factor in Hashimoto's and leaky gut can be a depletion of two key nutrients for gut health: L-glutamine, which is an amino acid, and zinc. Both are necessary for rebuilding the gut lining, and they can often become depleted because of high stress because they're also used in producing adrenal hormones. So you'll find zinc carnosine, the form that's especially good for the gut lining, as well as L-glutamine in leaky gut sealing powders like GI Benefits, which you can find in my Fullscript dispensary. But before you go out and buy that because you think you have a leaky gut, note that I generally don't recommend using something like that until you've healed up whatever gut infection you might have, like SIBO or SIFO or a parasite. SIFO is small intestine fungal overgrowth, by the way. And given it's one of the most common autoimmune diseases and what I'm very familiar with, and because it has a special relationship with SIBO, I'm just gonna go a little deeper on Hashimoto's because that's the cause of about 80% of the cases of hypothyroidism. So first, it was found in one study that more than 50% of people with hypothyroidism had SIBO as well, because the slowing of your metabolism from being hypothyroid causes a slowing and stagnation in your intestines leading to bacterial overgrowth. So this is often the case with constipation-related SIBO, but of course it can happen the other way around where SIBO causes a leaky gut that leads to Hashimoto's and hypothyroidism, as I already mentioned. Symptoms of hypothyroidism include constipation, pale dry skin, hair loss, muscle aches, weakness and tenderness, a goiter, like an enlarged thyroid, a puffy face, brittle nails, excessive or prolonged menstrual bleeding, enlargement of the tongue, memory lapses, depression, and joint pain and stiffness. If you have a TSH, or thyroid stimulating hormone, test and your level is above 2.0, which is still within the standard reference range but not the optimal one, and you have any of the symptoms or symptoms of SIBO, I'd recommend asking for further testing including thyroglobulin antibodies and thyroid peroxidase antibodies to rule out Hashimoto's. And if you do have SIBO, I'd recommend asking for your TSH to be checked because if your hypothyroid is caused by Hashimoto's, then you can address it naturally starting with gut healing and removing gluten and dairy from your diet., as well as testing and replenishing key nutrients like zinc, selenium, and iodine. Left unchecked or just medicated with standard thyroid medications, which by the way are important and necessary if you are hypothyroid, Hashimoto's will gradually destroy the thyroid gland, enlarging it and inflaming it. That's what my doctor told me would eventually happen to me in 2013 when I was first diagnosed. But happily, 9 years later, because I've done all the natural things I could to reverse the process of autoimmunity, my TSH levels remain normal and my antibodies have been normal for about 2 years now. Okay, so now on to what to do if you have an autoimmune disease and you want to try and put it into remission and reverse as much of it as you can and of the damage to your body. So this is a brief summary, but I work with people to help them do this, so please reach out if you need some help. First, you want to work to identify any food sensitivities using, at minimum, an elimination diet for 4 weeks of dairy, gluten, added sugar, artificial sweeteners— stevia and monk fruit are okay— alcohol, processed foods, processed seed oils, soy, and corn. If you have a very debilitating autoimmune disease, then I just go on a full autoimmune paleo diet and also eliminate other grains, pseudo grains, caffeine, nightshades, legumes, eggs, nuts, and seeds, including spices derived from nightshades and seeds. There's a specific way to eliminate and reintroduce foods on the AIP diet, so I'll link to a good resource for that in the show notes. Also, for some people, another helpful adjunct in decreasing immune activation and food sensitivities is proteolytic enzymes. One particular brand, Wobenzyme, has been studied and found to be particularly helpful in decreasing Hashimoto's antibodies when it's taken in large doses on an empty stomach. Second, you'll want to do stool testing or organic acids testing or both to determine whether you have any gut infections. Even if you're not symptomatic, sometimes a combo of different gut pathogens combine to mean you have neither diarrhea nor constipation, but you may still have an issue that's causing inflammation and a leaky gut. And of course, if you have any gut symptoms, then that's definitely a likely factor. And then usually herbal antimicrobials, probiotics, prebiotics, and polyphenols, either through diet or supplements. And digestive supports like betaine HCl to replace low stomach acid, pancreatic enzymes, or bile support may be needed depending on what's found on your tests. If nothing comes up in your gut testing, you may need to be tested for other viruses like Epstein-Barr to see if there's been a reactivation there, so you may need some antiviral support. Third, after gut infections are dealt with, a gut sealing and healing supplement is generally helpful in sealing up a leaky gut and rebuilding the gut lining. Fourth, you may need to test for and address nutrient deficiencies of key nutrients like vitamin D, omega-3 fatty acids, B vitamins, selenium, zinc, and magnesium, which can also be a factor in autoimmunity. Or at minimum, take a multivitamin, fish oil, and any other nutrients that show up as deficient on an organic acids test. Testing for nutrient deficiencies and supplementing where it's necessary is going to give your body the tools to help modulate your immune response, fight the bacteria and viruses, and support an appropriate, as opposed to an over exaggerated immune response, which is inflammation. Fifth, another factor that can often impede healing is a congested liver that's overloaded dealing with toxins, which can be identified on certain markers on an organic acids test, in which case there are certain supplements that are recommended to support your liver in detoxifying. In initial interviews, I always ask people about signs of potential heavy metal toxicity and mold exposure, but other basics are just making sure that your water is pure and you've eliminated toxins in your personal care products and home products, cookware, and food just to decrease the burden on your liver. 6th, since stress is so intertwined with autoimmunity, finding and addressing causes of stress and managing unchangeable causes is an important step. So that may involve starting therapy, ending toxic relationships, or starting a program of meditation, mindfulness, prayer, yoga, breathwork, ending a job that's driving you insane, that kind of thing. And finally, probably the most important step is persistence. Reversing autoimmune disease does not happen overnight. It takes long-term persistence and commitment to yourself and for caring for yourself and caring for your health. I was diagnosed with Hashimoto's in 2013 but didn't see my antibodies normalize completely until a couple years ago. So it took patience to eliminate foods, change my diet, clean out my liver, stabilize my nutrients, and then work on my gut health issues over and over until they were truly under control, and then stick with all those positive changes over time. But of course, the rewards are amazing if you can persist in all that. So if you're suffering from an autoimmune disease, the good news is that many people have reversed autoimmune conditions, even as serious as multiple sclerosis, and gone on to lead long, healthy lives. I work with clients to reverse autoimmune disease using the natural methods I just explained. It just takes an open-minded, willing spirit. So if you want to talk to me about what you've been dealing with and see if I can help, you can set up a free 30-minute breakthrough session with me through the link in the show notes, and I can let you know if I think I can help you and tell you about my 5-appointment Gut and Autoimmune Healing Program, and you can decide if that seems like a good fit for you, or you can just sign up for a single appointment. Links for all those things are in the show notes. And if you'd like to connect with me online, you can follow my High Desert Health Facebook page, join my Gut Healing Facebook group, or join my newsletter list at highdeserthealthcoaching.com, or find me on Twitter, Instagram, and Pinterest. And links for all that is in the show notes. Thanks so much for joining me today, and here's wishing you all the perfect stool.