Diet and Autoimmune Disease

 A while back a friend of mine, a pediatrician who suffers from  multiple food intolerances and a bowel disease called microscopic colitis (MC), was pondering how food is a foreign substance to the body and how it plays a role in disease development.  

There is mounting evidence that most autoimmune (AI) conditions may share a common thread, intestinal permeability (aka leaky gut).  When both my friend and I were in school learning about the functions of the GI tract, we were taught that it was basically impermeable.  Thanks to Alession Fasano, a pediatric gastroenterologist and founder of the Maryland Center for Celiac Research, we now know that there is a protein called zonulin that increases intestinal permeability.

For over a decade Dr. Fasano and his colleagues have been studying the role of intestinal permeability and how it contributes to CD and AI diseases in general.  Dr. Fasano says there is a smoking gun pointing at three factors present in many, if not all, AI diseases:  “an environmental substance that is presented to the body, a geneticallybased tendency of the immune system to overreact to the substance and an unusually permeable gut.”  In the case of CD the environmental factor is gluten.

Gluten is found in wheat, barley and rye, and that means that it is also found in large and trace amounts in a never-ending supply of processed foods.  In healthy individuals gluten stays within the GI tract, or if small amounts get past the GI tract, a healthy person does not get a significant response from their properly functioning immune system.  In CD, however, there are genes that contribute to a heightened sensitivity to gluten. But intestinal permeability is present in other AI diseases, such as Type 1 diabetes, rheumatoid arthritis, multiple sclerosis and inflammatory bowel diseases.

Since higher than normal levels of zonulin and intestinal permeability are being associated with AI diseases, it make sense to improve the integrity of the GI tract.  In the case of CD, there are usually telltale digestive symptoms and strict avoidance of gluten will promote healing.  However, other AI disease don’t necessarily have GI symptoms, yet intestinal permeability is still suspect.  Regardless of symptomology, optimizing the health of the GI tract is a first line of defense.

The case for gluten and CD is clear cut, but not so for gluten’s role in other AI diseases.  A growing segment of the population is gluten sensitive without having CD and people with AI diseases sometimes report an improvement in symptoms by following a gluten free diet.  Gluten has been in our diet for approximately 10,000 years, which is just a blip in time as far as our evolution is concerned.  But as my friend so aptly pointed out, our GI tracts are assaulted with many foreign invaders that are new to us.  Even so-called healthy foods have the potential to cause trouble.

Frustrated individuals suffering from a wide array of symptoms, many with diagnosed AI diseases and even more with no diagnosis at all, seek the services of a dietitian because they have some inkling that food is playing a role. AI diseases generally don’t have good treatment options, so looking at diet to provide some relief is appealing.  I work with these individuals on eliminating suspicious foods and seeing if symptoms abate.  What medical science has yet to answer though is, can we prevent AI disease by manipulating our diet and maintaining gut impermeability?

In time these answers will come, but until then, keep your mind open to the role that food can play in wreaking havoc in susceptible individuals.  My very wise pediatrician friend and I have also talked about our dream of having babies leave the nursery after birth with a customized diet prescription, one designed with their genetic makeup being taken into account.  One can only hope . . . .

Mary Beth George. MEd, RD/LD, LPC


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