I had the pleasure of going to the International Functional Medicine conference this year in Florida. The topic was ‘Solving the Puzzle of Autoimmunity: The Interplay of Gut, Genes and Environment’. All the top doctors that are treating autoimmune diseases successfully were at this conference and many were speaking. Dr. Fasano, MD gave the first lecture and it was fantastic. What follows are the notes I took that day.
There are over 100 autoimmune diseases now. 90% of chronic diseases are driven by the environment. Why is this and what is the root cause of this? The gut is a huge player in chronic disease as are allergens, toxins, infections, autogens. Autoimmune disease is highest in North America. We are not born with the destiny to develop chronic inflammatory diseases. We can change our destiny. Our genes, the environment, and increased gut permeability play a role. The immune response is involved; the microbiome is involved. Allergies can be turned on or off depending on the microbiome.
The cells play a role in immune homeostasis- epithelial cells, intestinal dc’s, B cells, T cells. The gut is a single layer of cells that interacts with our environment; the cells in the brush border have receptors that detect whether there are friends or enemies coming into the gut. These cells interact with our immune system and let the immune system know if we should be at war. The intestinal dc, B lymphocytes, immunoglobulins, secretory IgA shape the microbiota and function. T cells can create a lot of damage- can create chronic inflammation that goes to your joints, the brain, the thyroid, etc. If you have been exposed to the enemy before, you will have primed immune cells that are ready to go to war again.
When a situation of leaky gut is present, there is a loss of barrier function in the intestine. This can lead to inflammation/allergy and can initiate an immunoregulatory defect which can lead to proinflammatory allergic cytokines being released. This increased permeability can lead to a vicious circle of a breakdown in tolerance and create low grade inflammation. 1.Visc. hypersensitivity (IBS) 2. TH1 immune response chronic inflammation 3. TH2 response (food allergies) 4. TH17 immune response (autoimmunity).
The paracellular pathway-tight junctions which line the gut are not cement; rather they are dynamic levy bridges that are the dark horse implicated in a host of diseases ranging from acute injury to chronic inflammation. The zonulin gene is on chromosome 16 and is associated with diseases of the nervous system, cancer and autoimmune disease. Gluten causes zonulin release which opens up the tight junctions; causes an imbalance of the gut microbiome leading to dysbiosis which leads to bacterial overgrowth which then triggers further zonulin release.
Good bacteria in our gut are our friends and support us. Taking antibiotics drops a bomb on our microbiome. We were so wrong. This ecosystem is symbiotic with us. Look at the popular journal titles -Scientific American -Your Inner Ecosystem; Nature -Fellow Travelers. Environmental factors, diet, stress, etc change our microbiome. Gut Dysbiosis- the first 1000 days of life are instrumental for our clinical destiny. This is why it is advantageous to have a vaginal birth- a baby born vaginally is exposed to the proper milieu when it travels through the birth canal…