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Autoimmunity and the Role of Diet


The term “autoimmunity” encompasses a broad number of conditions, ranging from rheumatoid arthritis and lupus to inflammatory bowel disease, psoriasis, and various skin conditions. These conditions are all characterized by an immune process that inappropriately targets the body’s own proteins, rather than foreign proteins such as those of pathogenic bacteria and viruses. It is an immune response gone haywire. White blood cells and other immune cells identify the body’s cells as foreign, and mount an immune response involving the production of inflammatory chemicals, antibodies, and cellular attack mechanisms. Medications such as prednisone, methotrexate, and others, that powerfully suppress immune function, are typically used to treat these conditions. Although the role of diet is often overlooked, there is a large body of literature that attests to the potentially exacerbating effect of various food proteins. We explicate several lines of reasoning to demonstrate the role of food sensitivities in these disorders.
 



Impaired Digestive Function

Firstly, there is evidence of gross alterations in digestive function in individuals with various autoimmune conditions. In fibromyalgia, for instance, there is an association with the presence of leaky gut.[1] “Leaky gut” is a term that describes a situation where there is deterioration in the barrier function of the gut lining, allowing larger food particles to enter the bloodstream and trigger an immunological reaction. In a study of 40 patients with fibromyalgia, 17 patients with chronic regional pain syndrome, and 57 normal controls, patients with chronic pain had significantly higher rates of increased intestinal permeability compared with normal controls.[1] The presence of increased intestinal permeability, or “leaky gut,” has also been demonstrated in patients with juvenile arthrides.[2] Another study found elevated intestinal permeability in a group of patients with lupus, ankylosing spondylitis (AS), and another condition called Behçet’s disease.[3]

There is also evidence that dysbiosis, an imbalance of bacterial species living in the gut, exists in patients with autoimmune conditions, and that this is mediated by the effects of diet.[4][5] Furthermore, data shows that in patients with multiple sclerosis (MS), Sjögren syndrome, and rheumatoid arthritis, the extent of dysbiosis is associated with disease severity.[5][6][7][8] Since diet is one of the key determinants of the microbiome composition,[9] it follows that exposure to certain foods may be linked to dysbiosis and
the development of an inappropriate immune response.
 

Celiac Disease

Secondly, a number of studies suggest an overlap between various autoimmune conditions and celiac disease, a severe form of gluten intolerance where gluten triggers an immune response against the cells of the intestine itself.[10] A large Danish cohort study using data from almost 12 000 patients from the years 1977–2016 found that in 2016, the number
of patients with celiac disease who also had some other form of autoimmune disorder was 16.4%, compared with only 5.3% in the general population.[10] This is a three-fold higher rate of autoimmunity in patients with celiac disease. There are also associations between celiac disease and type 1 diabetes, as well as with fibromyalgia, psoriasis, and lupus.[11][12][13][14] In such patients, strict avoidance of gluten may result in significant improvements in the associated conditions.


Food-Specific Antibodies

Thirdly, food-specific antibodies have been identified in individuals with autoimmunity.
A study on rheumatoid arthritis found that these patients have increased levels of food-
specific antibodies present in their intestinal fluid, compared to normal subjects.[16] The
involved foods included proteins from cow’s milk (alpha-lactalbumin, beta-lactoglobulin,
casein), cereals, hen’s eggs (ovalbumin), cod fish, and pork meat.[16] Similar results
have been shown by an older study of proteins from wheat and milk.[17] Another study
of patients with ulcerative colitis found that these patients exhibited antibodies against
various cow’s milk proteins, present in their blood.[18] Similar results have been found
in children with liver disease as well as patients with Crohn’s disease.


Diet Restrictions

Fourthly, clinical studies have demonstrated that dietary elimination of certain foods via application of a hypoallergenic diet can alleviate symptoms and alter the course of various autoimmune diseases.[22] One study of 94 patients with rheumatoid arthritis found that following a diet eliminating foods including milk as well as certain dyes resulted in marked improvements in a subgroup of patients. These patients exhibited objective signs of improvement, and experienced clear aggravations upon re‑exposure to these foods.[23] Another study examined 40 patients with rheumatoid arthritis, and administered skin-prick testing to identify food allergens. Customized diets were then designed, and patients were asked to avoid exposure to their food allergens. Upon re‑exposure, patients with positive prick tests to those foods experienced clear aggravation in their symptoms as well as increases in inflammatory cytokines such as TNF‑α, IL‑1β, and C‑reactive protein.[24] Another study found that adherence to a gluten-free diet resulted in significant improvements among patients with fibromyalgia, irritable bowel syndrome, and
lymphocytic enteritis.[25]


Non‑Celiac Gluten Sensitivity

Finally, some researchers have gone so far as to create a new category of gluten
intolerance called non‑celiac gluten sensitivity (NCGS).[26] This refers to cases of
gluten intolerance where the patient tests negative for celiac disease. At present,
there is no diagnostic test for NCGS, so it is currently defined as “a condition associated
with . . . symptoms in response to ingestion of foods containing wheat, rye, and barley,
and the resolution of symptoms on removal of those foods from diet in individuals in
whom CD [celiac disease] and wheat allergy have been ruled out.”[26] The range of
symptoms reported may be quite broad, and includes abdominal pain, headache,
tingling or numbness in hands and feet, fatigue, musculoskeletal pain, skin rashes,
as well as rarer psychiatric conditions.[26] It may be that conditions that were previously
thought to be categorized as various autoimmune diseases, such as rheumatoid arthritis
or fibromyalgia, may in fact be manifestations of severe NCGS. We hope that continued
research may shed further light on this in the future.

In conclusion, several lines of evidence indicate that autoimmune diseases may be
influenced by an immune response against food proteins. Patients with autoimmune
diseases often demonstrate impaired intestinal barrier function and dysbiosis. There is
a higher rate of celiac disease amongst patients with various autoimmune diseases.
Food antibodies have been identified among patients with an autoimmune disease.
Clinical studies suggest that a hypoallergenic diet may benefit patients with an
autoimmune disease. Finally, the new entity of non‑celiac gluten sensitivity points to
the critical role of gluten in the etiology of some autoimmune diseases, and creates a
category for further research and analysis in this area.

If you are affected by an autoimmune disease, or think you may benefit from more
information regarding food sensitivities, please consult a licensed naturopathic doctor
for personalized recommendations.

 

References

1.     Goebel, A., et al. “Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome.” Rheumatology. Vol. 47, No. 8 (2008): 1223–1227.

2.     Picco, P., et al. “Increased gut permeability in juvenile chronic arthritides. A multivariate analysis of the diagnostic parameters.” Clinical and Experimental Rheumatology. Vol. 18, No. 6 (2000): 773–778.

3.     Fresko, I., et al. “Intestinal permeability in Behçet’s syndrome.” Annals of the Rheumatic Diseases. Vol. 60, No. 1 (2001): 65–66.

4.     Saresella, M., et al. “Immunological and clinical effect of diet modulation of the gut microbiome in multiple sclerosis patients: A pilot study.” Frontiers in Immunology. Vol. 8 (2017): 1391.

5.     Yadav, S.K., et al. “Gut dysbiosis breaks immunological tolerance toward the central nervous system during young adulthood.” Proceedings of the National Academy of Sciences of the United States of America. Vol. 114, No. 44 (2017): E9318–E9327.

6.     Buscarinu, M.C., et al. “Intestinal permeability in relapsing-remitting multiple sclerosis.” Neurotherapeutics. (2017) doi: 10.1007/s13311-017-0582-3. [Epub ahead of print]

7.     Mandl, T., et al. “Severe intestinal dysbiosis is prevalent in primary Sjögren’s syndrome and is associated with systemic disease activity.” Arthritis Research & Therapy. Vol. 19, No. 1 (2017): 237.

8.     Horta-Baas, G., et al. “Intestinal dysbiosis and rheumatoid arthritis: A link between gut microbiota and the pathogenesis of rheumatoid arthritis.” Journal of Immunology Research. Vol. 2017 (2017): 4835189.

9.     Wang, Y., et al. “A high grain diet dynamically shifted the composition of mucosa-associated microbiota and induced mucosal injuries in the colon of sheep.” Frontiers in Microbiology. Vol. 8 (2017): 2080.

10.   Grode, L., et al. “Prevalence, incidence, and autoimmune comorbidities of celiac disease: A nation-wide, population-based study in Denmark from 1977 to 2016.” European Journal of Gastroenterology & Hepatology. Vol. 30, No. 1 (2018): 83–91.

11.   Tovoli, F., et al. “Fibromyalgia and coeliac disease: a media hype or an emerging clinical problem?” Clinical and Experimental Rheumatology. Vol. 31, No. 6 Suppl. 79 (2013): S50–S52.

12.   Hagopian, W., et al.; TEDDY Study Group. “Co-occurrence of type 1 diabetes and celiac disease autoimmunity.” Pediatrics. Vol. 140, No. 5 (2017): pii: e20171305.

13.   Ungprasert, P., K. Wijarnpreecha, and W. Kittanamongkolchai. “Psoriasis and risk of celiac disease: A systematic review and meta-analysis.” Indian Journal of Dermatology. Vol. 62, No. 1 (2017): 41–46.

14.   Dahan, S., et al. “All disease begins in the gut: Celiac disease co-existence with SLE.” Autoimmunity Reviews. Vol. 15, No. 8 (2016): 848–853.

15.   Iqbal, U., et al. “Association of autoimmune hepatitis and celiac disease: Role of gluten-free diet in reversing liver dysfunction.” Journal of Investigative Medicine High Impact Case Reports. Vol. 5, No. 2 (2017): 2324709617705679.

16.   Hvatum, M., et al. “The gut-joint axis: Cross reactive food antibodies in rheumatoid arthritis.” Gut. Vol. 55, No. 9 (2006): 1240–1247.

17.   O’Farrelly, C., et al. “IgA rheumatoid factor and IgG dietary protein antibodies are associated in rheumatoid arthritis.” Immunological Investigations. Vol. 18, No. 6 (1989): 753–764.

18.   Aitola, P.T., et al. “The effect of proctocolectomy on serum antibody levels against cow’s milk proteins in patients with chronic ulcerative colitis, with special reference to liver changes.” Scandinavian Journal of Gastroenterology. Vol. 29, No. 7 (1994): 646–650.

19.   Lerner, A., et al. “Increased serum antibody levels against cow’s milk proteins in children with chronic liver disease.” Hepatology. Vol. 5, No. 3 (1985): 488–491.

20.   Lerner, A., et al. “Serum antibodies to cow’s milk proteins in pediatric inflammatory bowel disease. Crohn’s disease versus ulcerative colitis.” Acta Paediatrica Scandinavica. Vol. 78, No. 3 (1989): 384–389.

21.   Knoflach, P., et al. “Serum antibodies to cow’s milk proteins in ulcerative colitis and Crohn’s disease.” Gastroenterology. Vol. 92, No. 2 (1987): 479–485.

22.   Gaby, A.R. “The role of hidden food allergy/intolerance in chronic disease.” Alternative Medicine Review. Vol. 3, No. 2 (1998): 90–100.

23.   van de Laar, M.A., and J.K. van der Korst. “Food intolerance in rheumatoid arthritis. I. A double blind, controlled trial of the clinical effects of elimination of milk allergens and azo dyes.” Annals of the Rheumatic Diseases. Vol. 51, No. 3 (1992): 298–302.

24.   Karatay, S., et al. “The effect of individualized diet challenges consisting of allergenic foods on TNF‑α and IL‑1β levels in patients with rheumatoid arthritis.” Rheumatology. Vol. 43, No. 11 (2004): 1429–1433.

25.   Rodrigo, L., et al. “Effect of one year of a gluten-free diet on the clinical evolution of irritable bowel syndrome plus fibromyalgia in patients with associated lymphocytic enteritis: A case-control study.” Arthritis Research & Therapy. Vol. 16, No. 4 (2014): 421.

26.   Lundin, K.E., and A. Alaedini. “Non-celiac gluten sensitivity.” Gastrointestinal Endoscopy Clinics of North America. Vol. 22, No. 4 (2012): 723–734.

 

 Philip Rouchotas, MSc, ND

 Well-known in the community as a naturopathic doctor, associate
 professor, and editor-in-chief of Integrated Healthcare Practitioners.

 



 

 Heidi Fritz, MA, ND

 A practicing naturopathic doctor since 2007, her areas of focus
 include women's health, children's health, chronic pain, and more.