By Julie Hoskin, B.S., M.B.A., N.T.P. and Vernon Rowe, MD
Increased intestinal permeability has been found in every autoimmune disease in which it’s been studied. This is true for autoimmune disease of the gut like Crohn’s disease or ulcerative colitis but also true of others such as rheumatoid arthritis and multiple sclerosis. It now appears that people with Ehlers Danlos Syndrome/Hypermobility Syndromes have excessive gut permeability issues as well.
The intestinal wall is lined with a layer of epithelial cells which is indeed semi-permeable. This allows the absorption of the nutrients we need to pass through and get absorbed via either the bloodstream or the lymph system. But when increased intestinal permeability exists, many substances which should not cross from the gut into the inside of the body do. These could include bacterial fragments and endotoxins as well as undigested foods (due to upstream problems with digestion, mainly insufficient stomach acid). When this happens, the immune system located in the gut (Peyer’s Patches and more generally, Gut Associated Lympathic Tissue(GALT)), reacts. The response to bacterial fragments and endotoxins is an innate response and produces general inflammation which can exacerbate autoimmune disease and cause other health issues though is not a direct cause of autoimmune disease.
The main issues with autoimmune disease in general may be the undigested proteins which cross the barrier. These undigested proteins are not recognizable to the immune system as nutrients. Rather they are recognized as invaders, and an acquired immune response is mounted against them. Antibodies are created to attack these proteins. If these antibodies are IgE antibodies this is considered an “allergy”; if it is any of the other classes of immunoglobulins (IgM, IgD, IgG, or IgA) it is considered a “food intolerance”. Because some of the amino acid sequences in these foods (and actually some beneficial bacteria as well) are similar to human tissues, the immune system can create autoantibodies, thus causing autoimmune disease. (Depending on the health of the overall immune system, some people are able to regulate these autoantibodies before they become pathologic.)
There are many causes of intestinal permeability. They include sensitivity to dietary components (specifically gluten, grains, legumes, egg whites, and nightshades), stress, medications such as NSAIDS and corticosteroids, and alcohol. People with Ehlers Danlos-Hypermobility Syndromes are particularly susceptible to having excessive gut permeability because of the same connective tissue deficits that cause hyperflexiblity in their joints.
Gut dysbiosis is another major factor in autoimmune disease, since the beneficial bacteria in our guts play a role in modulating the immune system. If these are absent or disproportionate to “bad bacteria”, the regulatory arm of the immune system can be impacted, contributing to autoimmune disease. Contributors to gut dysbiosis are incomplete digestion of proteins (caused by low stomach acid as previously mentioned) and/or fats caused by liver or gallbladder issues, including low-fat diets which do not stimulate the release of bile and may have insufficient cholesterol to stimulate production of bile.
In addition to immune modulating activity, gut flora is also responsible for creating endogenous butyric acid. Butyric acid is important in cellular repair in the intestine, so deficiency can worsen increased intestinal permeability.
Contact Information: For additional information and nutritional consultation see Julie’s website Never Settle Health and Nutrition. available for video chat (or In-person in Santa Monica) with free initial consultation.
References:
“The Paleo Approach” by Sarah Ballantyne
“Regulation of inflammation by microbiota interactions with the host” by J Magarian Blander1 in nature immunology VOLUME 18 NUMBER 8 AUGUST 2017