Vitamin Deficiency and Autoimmunity (Part V)

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For this section, I am going to focus on fat soluble vitamins specifically, which means vitamin A, D, E, and K. Fat soluble vitamins can be stored for later use unlike water soluble vitamins and tend to be the most deficient in the American diet for various reasons.  Each one of the fat soluble vitamins has potent effect on the immune system and therefore, deficiency in any of them, can put us on the path to immune system disorders (if we aren’t already there).  Fat soluble vitamins are found widely in animal products, so this tends to be a sticking point in the world of plant power.  Don’t worry though, even if you are a vegetarian, you can still get these vitamins without having to eat meat.  If you are a vegan, however, this may a trickier component to address.

Vitamin A. Vitamin A is important in the scope of autoimmunity because it is important for maintaining mucosal barriers.  You know just how imperative this is for the avoidance of leaky gut which is the precursor to every autoimmune disease if you read my previous articles.  Vitamin A also plays a major role in inflammation due to its connection with neutrophils, macrophages, and natural killer cells.  If someone has depressed immune system due to Vitamin A deficiency, they are at great risk for repeated infections.  One can always turn to supplements, but I would rather have someone get this nutrient through food.  I will never quit saying “food is medicine.”  You can find it in grassfed butter, liver, and pastured egg yolks.  If the animals producing these products are not eating their appropriate diet, however, these are not present in nearly the same quantities.  This is the reason I hit home the idea of food quality being worth every penny.

Vitamin D. Vitamin D is my favorite to talk about because most patients come to me with standard blood work including vitamin D.  This is a testament to the agreement among most all health professionals how important it is! We have the most research on Vitamin D; therefore, we know it plays key roles in the expression of over 200 genes and the proteins associated with those genes.  We need it for mineral absorption and bone health.  Vitamin D is essential for healing via its pathways that help cell growth.  AND, it is important in immune system regulation.   Vitamin D is so closely linked to autoimmune diseases that it has been suggested the deficiency may be the  CAUSE (via environmental trigger) of lupus, diabetes type 1, MS, rheumatoid, psoriasis, and IBD.  We see geographic implication too when we consider RA.  We know for a fact that stats show higher rates of RA the further away from the equator.  Why would this matter?  Because most Americans are relying on sunlight as their source for Vitamin D production.  It is synthesized from cholesterol found in the cell membranes of skin cells when we absorb UVB rays from the sun. Someone reading this may be thinking “Great!  I’ll go get some Vitamin D supplements today!”  I wish it were that easy.  Vitamin D works alongside other fat soluble vitamins in addition to plant nutrients  and hormones.  Just taking a Vitamin D supplement doesn’t address the increased need for the other nutrients.  This gets crazy and complex in the world of supplementation.  You’d take 1,000 supplements and still not touch all the things you get from real food.  Additionally, if you didn’t address the dietary aspects like wheat, then you are ingesting foods that actually reduce Vitamin D in the body! Lifestyle matters.  There is no shortcut to going outside in the sun, ingesting healthy fat sources, and avoiding toxins and inhibitors.  Let me repeat: there is NO DRUG OR SURGERY that can make up for a lifestyle issue.  Period.  *Vitamin D levels for someone with an autoimmune disease need to much higher than the general population; therefore, being within normal range is not adequate!

I’m going to skip Vitamin E and say a quick word on Vitamin K because this one tends to be gaining clout in the health industry. Vitamin K is also essential for bone and tooth health and studies are being done on its link to osteoporosis for this reason.  It also plays a role in protecting against oxidative damage and regualtes the immune system.  Unlike other fat soluble vitamins, you can get this from fermented foods in addition to pastured animal products!  Bacteria produce this when they are doing their job and therefore, your bacteria in your gut can also make Vitamin K in your small intestines by converting K1 that they find in your leafy greens!  Let’s hope you haven’t been taking antibiotics regularly, or you may be at a deficit here, too.  Your bacteria levels are so important, and anything working against them is also helping the disease pathways catapult.

So, let’s just think about this full circle for a moment.  You were born with genes that give you a predisposition for some of this.  However, you don’t have it expressed necessarily unless you create the right environment.  You create that environment by taking antibiotics, heartburn meds, staying away from the sun (or blocking it), lacking grassfed animal products in your diet, eating things like wheat (possibly every meal!), and we haven’t even talked about the connection of stress! or exercise!  or sleep! or chemical exposure! You can now see why we have taken a massive wrong turn in our society when it comes to our food supply providing us nutrients, our lifestyles prioritizing stressful and depleting behaviors, and then our tools for correction are not addressing the underlying causes.  That is why we are not getting better.  That is why people get sick and stay sick.  That is why, despite the fact that I am ONE PERSON, I am on a mission.  Even if you read this and never do anything about it, I have done my job.  I am not here to make a decision for you.  But if you choose the same decision given all the information, then at least it’s informed decision making.  That’s more important to me than anything.

The Golden Spiral: Nature’s Evolution

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Recently, I have become obsessed with something known as the logarithmic spiral, aka “the golden spiral.”  I’m not a math geek, so I won’t go into the formula, however, I do want to explore the meaning.  The other day, I decided to wear my nautilus shell to work.  I very rarely wear any jewelry that doesn’t have some meaning to me.  You’ll very rarely ever see me wearing rings because I use my hands with patients, the barbell isn’t kind to any sort of metal, and sand has an uncanny way of getting forever wedged in crevices. Therefore, I prefer bracelets and necklaces.  As I  put on my necklace, I started reflecting on what the shape of the shell really represents.  The Swiss mathematician, Bernoulli, said it best when he described the spiral as representing the latin motto: Eadem mutata resurgo.

In Engish, this means “Changed and yet the same, I rise again.”

A logarithmic spiral gains speed as it moves further from the center.  It’s shape remains the same but it’s growth is exponential.  This is a direct reflection of organic growth.  You see it in the Milky Way, romanesco, plants, the nautilus shell, etc.  The bigger these things become, the faster they grow. This pattern is also seen in people and their lives.  I work with so many patients that have stories, stories of misfortune and triumph, stories of change, stories of loss, stories of life….

Everyone has a story that represents them and their journey thus far.  From a small child to the point in time which they are alive today, they are the same being.  They have the same DNA, their soul is the same soul that entered this world; however, they are larger in form, and have grown exponentially in spirit.  Every trial, every triumph has compounded itself to growth that is bigger than the lesson before.  People change, yet are still the same.

I am no different from everyone else.  I get giggles and crazy looks when I talk about how I can’t wait to be 40, 50, 60.  I say this because I have enjoyed my entire journey of life thus far and have grown exponentially with every day, every experience, every gift, every fail, every breath.  I can only imagine how much wiser I will be if I continue on this path of exponential growth.  Everything I have done up to this point has created a foundation for the growth to come.  I never thought I’d be where I am today based on the foundation I put down 10 years ago.  For this reason, I never try to predict the future, yet I am excited for its arrival.

I am so grateful to be on the journey of life changes with patients and I see this growth with my own two eyes on a daily basis.  From the day I start working with my patients to the day they are released, they have changed, yet are the same.  They rise again as a changed being ready for the next chapter.  They will change again at some point.  However, through all the change, their core being is still the same.  Nature is my constant source of inspiration and I couldn’t have said it better when it comes to this golden spiral.

Adrenal Fatigue: Understanding Cortisol

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This is a condition that really doesn’t discriminate between healthy and unhealthy individuals.  I have had countless patients end up at my door with relentless fatigue when they believe they live a healthy lifestyle.  They workout, they don’t eat excessive carbs, they have successful jobs, and they take their daily supplements!  Then why are they SO tired all the time?!  These cases are almost always issues with cortisol production and the ability of the adrenals to keep up with stress.  Athletes especially can be affected by this issue because of overtraining, chronic stress, or lack of appropriate recovery.  Sometimes less is more, but let’s take a look at what actually happens in someone with adrenal fatigue.

Adrenal Glands: You’ve go these two little organs that sit on top of your kidneys that are responsible for releasing epinephrine and norepinephrine, aldosterone, cortisol, sex hormones, and precursors such as DHEA.  Cortisol is a steroid hormone that is responsible for all kinds of things in the body including:

  • mobilizing protein stores
  • water excretion and electrolyte balance
  • mobilizing fatty acids from adipose (fat tissue)
  • precursor to cortisone (and anti-inflammatory agent)
  • directing immune function
  • stimulation/inhibition of gene transcription
  • affecting bone calcium
  • affects behavior, mood, and hormones
  • affects numerous CNS biochemistry

Basically, it has a hand in tons of things.  Like most body chemistry, it is definitely not on an isolated island!  When stress levels are high, the demand for cortisol production goes up.  However, the building blocks are things like progesterone and pregnenolone which are needed for the production of other hormones.  When your body starts stealing these building blocks to keep up with stress, it will eventually let your other hormones like estrogen and testosterone suffer in order to keep up.  This is important because many people are known to have hormone imbalance, but if you never assess the adrenals, how do you know this isn’t the reason?  If it is, then the answer is not hormone replacement, the answer is stress reduction that will in turn lower cortisol demand.

When you start thinking about how important hormones are to the body, one may ask why on earth your body would make that kind of sacrifice?!  The simple answer is that our body is still expecting stress to be a short-lived event driven by a life or death incident.  In that moment, we would sacrifice anything in order to get out alive.  We never adapted a mechanism to take care of chronic stress.  Stress that never goes away. Stress that takes all we have.  Stress that leaves us feeling defeated at the end of the day and dread the start of the next.  Am I ringing any bells here?  Life is HARD these days!  We have all kinds of stress!  Work!  Kids! Relationships!  But, we also have stresses that people don’t think about like food sensitivities, sleep deficit, overtraining at the gym, and infections.  There are ALL stress to the body.

This is how people can function from day to day, still go to the gym, think they are doing it all, and still feel like crap.  When I run cortisol panels, it’s not uncommon for me to find cortisol levels that are in no way keeping up with the demand.  There are symptoms many complain about:

  • hypoglycemia
  • chronic fatigue
  • ligament/cartilaginous injuries
  • depression/anxiety (this one I see a LOT!)
  • insomnia
  • irritability
  • short term memory issues
  • pain that persists
  • poor wound healing and workout recovery
  • frequent colds
  • hypothyroidism (tons of my ladies out there have this along with adrenal fatigue!)
  • PMS
  • infertility
  • menopause symptoms (can we say hot flash club?!)
  • insulin resistance
  • fat around the trunk

The test for this is pretty simple, but it’s important to have it checked multiple times throughout the day.  So, many physicians will test it once.  That is not helpful unless there is pathology.  We are looking for optimal function.  Therefore, we want to see a high number in the morning and a gradual decrease until it bottoms out at night so you can go to sleep!  If we don’t see that, we need to assess where we are in order to know where to go from there.  In the early stages, people will make too much.  They usually don’t come in for help at this stage because they are “keeping up” as far as they’re concerned.  By the time we hit stage 2 or stage 3, we are starting to not be able to keep up and we start stealing those building blocks from other hormone pathways.  THIS IS USUALLY WHAT BRINGS THEM IN!  On top of fatigue, they now have stray hairs growing in random places, excessive fat that won’t budge, inability to recover from their workouts, trouble sleeping, up and down emotions, loss of sex drive.  At this point, we can’t just fix it with food, typically.  We need to “help your body over the hump” so it can catch up and produce enough cortisol again on its own.  This not only takes time, it takes lifestyle changes that may include cutting things out that are contributing to stress.  This is the toughest thing for patients to do.  If they don’t workout as much, say no to responsibilities, sleep more, etc, they feel LAZY!  You wouldn’t call a cancer patient LAZY!  This is taking care of yourself, and I can’t stress it enough (no pun intended).

If this sounds like you, and you like help, my door is open.  The saliva test I use to measure cortisol, DHEA, hormones, and melatonin is around $200 and it is done at home.  Doesn’t get much easier than that for a little piece of mind and direction.

Prosciutto-wrapped Stuffed Chicken Breasts

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I use the trick of stuffing chicken breast with pesto ALL THE TIME.  I do this for 2 reasons: 1. It keeps the meat moist. 2.  Pesto is something I have sitting around all the time because of having so many herbs throughout the summer.  It adds flavor and makes it seem like you spent all day in the kitchen. I even use it from the frozen pesto cubes I make.  It makes it seem like tons of work went into something, when it sure as heck did not! I decided to use up some prosciutto I had in the fridge, too but this could easily be left off or you could sub bacon.  While this was roasting, I threw some onions and fennel with a few cherry tomatoes on a baking sheet to roast on another rack as a side dish.
Proscuitto-wrapped Stuffed Chicken Breasts
Ingredients:
2 lbs chicken breasts, skinless, boneless
4 Tbsp pesto (you could use cilantro pesto just as easily!)
4 sheets of proscuitto
salt and pepper
Directions:
Peheat oven to 350F and cover a baking sheet with parchment paper.(picture instructions below)  Lay out 4 chicken breasts on the paper and create a small pocket by using your knife to separate the breast so it opens like a book but not completely cut in half.  Once all those pockets are created, wash your hands and salt and pepper your breasts.  Then using one hand, open the pocket, while using the other to scoop your pesto inside.  Once you are done with the pesto, you can use both hands to squish it further into the pocket to make sure you get good coverage.  You want most bites to have some pesto in it!  (kind of like a cream filled donut).  Then wrap a sheet of prosciutto around every breast and bake in the oven for 30 minutes or until the breasts are cooked through.
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Why I order Chicken at Chipotle

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I have been traveling all week to fill in for another doctor and there happens to be a Chipotle down the road from the office.  Hallelujah! I am pretty good about packing food to take so I don’t get hangry, but Chipotle can be a nice place to grab food, sit down, and eat outside.  Now to get to the point.  Why would I order chicken at Chipotle when I very rarely eat chicken at home?  There are a couple things I like to consider when eating out:

  1. What basic food options are available?
  2. What is the meat quality?

When eating out, I am always looking for basics, whole foods, simple ingredients.  You can’t get everything perfect at a fast food restaurant, but that doesn’t mean I dive into a McDonald’s cheeseburger by any stretch of the imagination.  Chipotle has veggies, meat, healthy fats, in-house prepared additions, and tries their best to pick non-GMO, higher quality sourcing options.  So, as far as basic food options, I can get a filling, whole food meal.  That takes care of WHERE will I eat.

The second concern now that I am WHERE I’m going eat, is WHAT am I going to order?  I am not afraid of fat by any stretch of the imagination, and healthy fats are abundant in my diet, including the fat from grassfed meat, skin from chicken and salmon, rendered fats for cooking, etc.  However, when I am dining out, unless it specifically says that the cow products are grassfed, I try to order chicken.  Chicken is much higher in omega-6 fatty acids than grassfed cows even if it is pastured and fed appropriately.  Grassfed cows actually have tons of omega 3 fatty acids, which are healthy, anti-inflammatory, and much more effective than supplementation.  However, if the cow has eaten grains, you can chuck those omega 3’s out the window.  Now we are looking at 2 foods that are both heavier on the omega 6 fatty acid side of the equation.  So, we will call it a tie.

Now that I have established neither option has eaten appropriately, I look for the leaner option and that is typically chicken.  Why would I care about the leaner option?  Because adipose tissue (aka fat, marbling) tends to be a storehouse for toxins that have not been mobilized and excreted.  This means, if the animal ate what it wasn’t supposed to, it’s fat products are far from healthy.  It is no longer a meat product with abundant health benefits.  It is now sort of inflammatory, potentially toxic, and should be looked at for it’s macronutrient value alone (protein).   Chicken in the US has gradually made it’s way toward white meat, meaning that it’s fairly lean.  Even if the chicken isn’t pastured, I am not getting much of the toxic load associated because I am not ingesting it’s fat, like skin, dark meat, and schmaltz.  If I eat a leaner meat, it’s choosing the better of two inappropriately fed animals in my opinion.

I make sure to bridge the nutrient gap with healthy plant fats like avocado.  I will order lettuce, chicken, fajita veggies, mild salsa, and a heaping dose of housemade guac.  You may also notice that I don’t even really have a drink sitting around.  I will discuss drinking water during meals at a later time, but for now, weigh your chicken vs beef options when choosing fast food.  If the chicken were breaded, I would choose the beef.  It’s all about priorities.

Gluten’s Part in Leaky Gut and the Autoimmune Cascade (Part IV)

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If you have been following along, we have now established how an autoimmune disease starts, what gut permeability is, how stomach acid may be a problem, and now we can start talking about what causes it in our lifestyle that we can control!  On one hand, I am oversimplifying this part of the discussion so that I can focus on the aspects that you can actually have control over.  I am skipping over some of the things out of our control like certain genetic attributes, environmental exposures, and infections that may have been just bad luck in terms of wrong place, wrong time.  However, even those factors can be overcome most of the time with proper care.  So, lets get to it!

Gluten: Yes, I am starting with our beloved friend, gluten.  Why?  Because this is the most controversial topic that flies around and it’s simply hard for most people to understand how on Earth, eating a bagel and some bread can cause such a problem as serious as autoimmunity….especially if their physicians haven’t said a word about it, or may have even discounted the connection when a patient asks.  If I could have everyone start with A SINGLE change, this would be it.  Antibody production against gluten has been reported to affect as much as 30 percent of the population!  The mechanism by which it contributes to leaky gut has to do with zonulin.  Zonulin is a protein sent into the gut by that single layer of cells called enterocytes and regulates the opening and closing of the tight junctions (shout out to all my AP101 students!  remember those tight junctions I tested you over?!) that hold the cells together.  They are kind of like the pegs that allow legos to fit together in a flush manor.  Gluten has the ability to increase zonulin and therefore increase the amount of time those tight junctions are open, allowing undigested proteins, bacteria, and toxins to cross over inappropriately.

There are also pathways where a enzyme known as transglutaminase is affected.  Transglutaminase is an enzyme that is important in protein modification as they are produced in the cell.  (I promise to not start talking about transcription and translation!) This enzyme activity is increased in the lining of the intestines when we consume gluten.  Increase of this enzyme’s activity increases the likelihood of antibody production against gluten.  The bigger issue is that if antibodies are produced against this enzyme, we can’t perform tissue healing like we normally would. So, let’s say you have tissue damage and one of your body’s ways of helping heal it is to send transglutaminase to the site, but because of increased gluten ingestion, you have created antibodies against it.  Now you are sending this enzyme to all these sick parts and your immune system is going “OMG, what is he doing here?!  Produce more antibodies!  We are gonna need ’em to eradicate him!”   When you start eating a gluten free diet, you decrease the antibody formation against transglutaminase and you decrease zonulin activity, which allows those junctions to stay shut.

*This part is my opinion although is a topic of discussion.  Why now and not before?  Wheat has changed in various ways.  We have changed it from Einkorn wheat to dwarf wheat in order to increase crop yields and increase gluten levels for desired texture of baked goods.  We also now have an issue with Round Up Ready seeds causing damage to our DNA by damaging the microorganisms living in our gut.  We are also not preparing wheat products like we originally did.  We no longer, soak, sprout, or ferment grains.  We NEED to do that in order to get nutrients out of the bran.  Anyway, I don’t know what the largest contributing factor is, and it may just be a combo; but I do know, that many patients do extremely well without these products in their diet.

According to Dr. Peter Osborne (who is an expert on gluten sensitivity), there are 140 autoimmune diseases that science has identified and the ONLY SCIENTIFIC agreement for the cause has to do with gluten and its many mechanisms by which is can cause this cascade of events.  I chose not to focus on a few of the other pathways that I usually do in a health talk like lectins and their contribution.  However, know that there are even more reasons that gluten can cause changes to the intestinal wall!

I’m going to stop there and do another article on more causes because this could get overwhelming.  So, what can you do TODAY?  Try to cut out all of the wheat products in your diet and see how you feel.  No bread, pasta, pizza, donuts, beer, etc.  When you think about it, you may be consuming these things multiple times a day!  If it’s contributing to your issues, you can also understand just how damaging it may be to consume them so regularly.  This alone, will not likely cure anything, but it may give you a huge step in the direction of feeling BETTER.  Most people with autoimmune diseases are willing to entertain the idea that something can make them feel better, and you can only gain other health benefits in addition if you cut out all those junk foods often containing wheat.  Check out my blog recipes for more ideas, but there are so many options out there!  Don’t get overwhelmed.  Just start.

Heartburn and Autoimmunity (Part III)

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I can’t count how many patients I’ve worked with over the years that have heartburn.  Most take some type of buffering agent to neutralize the acid such as Tums.  However, for the more severe cases, they will be prescribed a Proton Pump Inhibitor.  This is such a huge deal that I make my physiology students look this up and write an entire paper on how they work!  You do NOT want to inhibit the function of your cell membrane’s proton pump!  Most people can get on board that shutting down a system in the body may not be a good idea, but they don’t know the alternative options available.  That’s where understanding exactly why stomach acid is getting in the wrong place is imperative to fixing the problem for good.  That topic may be for another time, but for now, we are going to make the general statement that most cases of heartburn are actually cases of NOT ENOUGH stomach acid.  Therefore, taking meds to decrease the production even further drives us into a hole that is tough to get out of.  If you just trust me on that statement for the time being, we can look into why decreased stomach acid may play a role in the development of an autoimmune disease.

The stomach is the first stop in the tube after you swallow your food.  It has been designed to have a very acidic environment by the production of HCl.  The reason we need such an acidic pH (around 2), is because that acidity will start the breakdown of your food, kill many bacterial organisms that we do not want making it into the small intestines because they could make us ill, and is needed for vitamin and mineral absorption.  This acid is specifically important in the breakdown of proteins into their legos, amino acids.  (Remember how we need to first breakdown all of our food into it’s smallest components in order to absorb it.)  If this stomach acid plays so many crucial roles, you can imagine the domino of effects that may occur if there is not enough of it around.

When you aren’t producing enough stomach acid, the pancreas and liver aren’t getting the signal to release digestive enzymes and bile, which will mean your food will further lack breakdown.  If these stages of breakdown don’t occur, you can end up with nutritional deficiencies because you aren’t able to absorb things in such large forms.  I see this a lot with Crohn’s patients; men especially can be so skinny because they simply aren’t able to get nutrition absorbed! So, now we have undigested food in the small intestine, which creates the perfect environment for opportunistic bacteria and yeast to grow out of control.  If you have heard the term SIBO (Small intestinal bacterial overgrowth), you know how this can be troublesome for patients who are “eating perfectly” because that specific case requires  therapeutic protocols to actually fix it.  Until the overgrowth is addressed, you won’t digest anything appropriately no matter how perfect your diet.

Low stomach acid specifically impairs the digestive process and creates the perfect environment for bacterial imbalance in the gut.  Remember me talking about how you have 10 times the amount of bacteria in your gut then cells in your body?!  It’s crucial to have abundant good bacteria, and minimize opportunistic microorganisms.  Without balance, we have something called dysbiosis.  Dysbiosis is at the root of so many health conditions including autoimmune diseases because of the risk of infections, nutrient malabsorption, and the impaired integrity of the intestinal wall.  We don’t want an environment where the wall can be leaky, we have bad bacteria hanging around, and large protein structures on top of it.  If those things cross over the wall of enterocytes and  come in contact with the immune cells on the other side, we have just triggered an immune system response to our food.  All of this being a domino effect of NOT HAVING ADEQUATE STOMACH ACID!  That Nexium or Prilosec isn’t helping matters.

I want to throw out a couple things that can be common in patients.  One is H. Pylori.  This organism can overgrown in patients with low stomach acid and the infection NEEDS to be addressed before you can move forward.  The test I use cost about $100 and is worth every penny.  The other thing is that patients don’t often need stomach acid reducing meds, they need supplements that encourage the production of more!  When your body produces enough stomach acid, it’s the signal to the esophageal sphincter to close.  The reason you feel burning in the esophagus is typically because that “door” between the stomach and the esophagus hasn’t closed adequately.  Stomach acid in the esophagus doesn’t feel good and if left alone chronically, it can cause Barrett’s esophagus and cancer.  No good.

You can increase stomach acid by taking HCL/pepsin supplementation with meals, eat digestive bitters, drink a glass of water with lemon juice or apple cider vinegar in it 20 minutes before a meal, or indulge in a little kombucha.  I would also suggest a good probiotic to patients in this situation because you need to rebalance the microbiome.  I have links to ones I like in the “store” along the top bar.  It will send you to the products through Amazon. While these are great tips, I want to caution people from taking this upon themselves because if HCl is taken in conjunction with asprin, Advil, corticosteriods, etc, it can actually cause serious damage to the gut lining and cause ulcers.  Also, if a pathogen is present such as H. Pylori or SIBO, then more steps have to be taken to address that.  Moral of the story is that if you are taking meds to lower stomach acid, you most definitely have an underlying issue that is not being addressed.  You are simply masking the symptom of acid getting into the esophagus.  I would encourage you to ask why it would get there in the first place?  That is not normal.  Stomach acid was created for proper digestion and nutrient absorption, so any substances that would try to increase the pH to be more alkaline, is going to have a detrimental effect.

If you have an autoimmune disease that you are taking an immunosuppressant for, can you imagine the environment we are setting up for disaster if you have stomach acid issues that are allow bacteria to overgrow AND the meds you take are shutting down your immune system?!  Oh my.

I want your heart to be on fire, but just not due to low stomach acid.  Love you guys!

Intestinal Permeability and Autoimmune Disease (Part II)

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I have written several articles about our bodies being hotels for bacteria, and when the bacteria levels are balanced and the microorganisms are happy, we are healthy.  These bacteria make up so much of our immune system, its hard for me to fathom why we haven’t placed more focus on their role in studying disease.  It’s gaining traction, and therefore most people have heard the buzz phrase “leaky gut” thrown around somewhere.  In this article, we are going to discuss what it actually is, and how it has to do with autoimmunity.

Let’s start with the basics.  From your mouth to your anus, you have one long tube with stops along the way.  The mucosal barrier that keeps food in the tube, and not in your tissue, it technically ON THE OUTSIDE!  I know it sounds crazy, but that tube running down the middle of your body is an exterior surface. It’s comprised of a single layer of cells; that’s it!  Pretty amazing if you think about how food goes in one and end and comes out the other.  After food goes in your mouth, it has stops along the way and one of them is in the small intestines.  The small intestines is where most of your nutrients are absorbed into the body. The way nutrients get into the body through the section of tubing we call the small intestine is by specific breakdown that occurs via acid, enzymes, bile salts, and bacteria.  Proteins are broken down into their lego parts, amino acids.  Fats are broken down into fatty acids, and carbs are broken down into simple sugars. Once food is broken down into its simplest form, it’s ready for transport into the body.

In order to get into the body, digested nutrients have to cross that single layer of cells called enterocytes.  On the other side of the wall lives blood vessels, lymph vessels, and immune cells of the gut.  The amino acids, simple sugars, minerals, and water soluble vitamins (like B vitamins) are transported via blood and the fatty acids and fat soluble vitamins (like A, D, E, and K) are transported through the lymph. A leaky gut occurs when there is damage to that single layer of cells and things that shouldn’t be able to cross over, do.  This damage can occur by sections of cells themselves being damaged, or the bonds between them being broken. When this happens, now we have things like pathogens, incompletely digested proteins, bacteria, and toxic substances entering the territory where immune cells live.  The immune cells immediately recognize them as foreign and plan an attack.  However, if any of them get through that line of defense, now we have them floating in the bloodstream. The body frantically tries to clean it all up, and this produces a fairly global inflammatory state.

I think it’s worth mentioning that those undigested proteins stimulate a part of the immune system that produce IgE antibodies.  Food allergies that cause difficulty breathing, swelling, ER visits…those are due to this IgE response.  This is a TRUE allergy.  However, when antibodies such as IgGs are produced, this is what we call a food sensitivity. The reason we call it a sensitivity is because the immune response produces symptoms of allergies for example, fatigue, mucus drainage, inflamed sinuses, and possibly even things like eczema.  This is what doctors are testing for when they do a blood panel for food allergies!  If you have ever had a food allergy/sensitivity test and it came back with a list of crazy amounts of foods like chicken, spinach, strawberries, etc., you are most likely NOT allergic to those foods.  This is nothing more than a IgG production because food proteins got into spaces they don’t belong.  Once you heal the gut and keep those foods from crossing the gut lining, your body will QUIT producing antibodies against them.  I see this all the time when I work with food allergies.  You can absolutely resume eating most of those foods without issue as long as appropriate care has taken place.  I got off track….back to the antibodies. Of those antibodies being produced, some can be autoantibodies.  When cytokines (chemical messengers) are released, it stimulates both the innate and the adaptive immune system.  This pokes the bear of the adaptive immune system that can result in an autoimmune disease.  If you remember from the previous article, this is where amino acid sequencing can get confused for our own tissues.

I hope I didn’t lose anyone with crazy words, but I think this connection between how the food we eat gets to places it shouldn’t, and the immune response that results is an important one to know!! Why? Because autoimmune diseases live in about 50 million DIAGNOSED people and cancer is only 12 million.  Heck, heart disease is 25 million!  Needless to say, this costs our country more than just $100 billion dollars in direct care costs, it is costing us our quality of life!  Anytime I have a patient that is able to go about their day without worrying about the symptoms of an autoimmune disease, I do a happy dance.  It gives them their life back!  This is priceless.  In the upcoming articles, I will talk about which foods can create the perfect storm, and other lifestyle factors that damage that single layer of cells that keep the good stuff in and the bad stuff out.  These are things you CAN CONTROL!  I’m getting pumped up…can you tell…welcome to what it feels like to be in the audience when I give a talk.  I just can’t help myself….

Pineapple Whip (3 ingredients)…Plus Protein

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I’ve posted about ice cream made out of frozen bananas before, but I had never seen it made out of frozen pineapple until recently!  Apparently this is something they serve at Disney Land?  I wouldn’t know.  Anyway, I wanted to stay pure to the simplicity but add a little protein to it.  I used full fat coconut milk as the liquid to make sure there was a decent fat ratio, as well.  Feel free to do whatever you’d like to this recipe!  Top with toasted coconut, add protein powder as a post workout recovery, or add spices like nutmeg, cinnamon, and chili powder!
Pineapple Whip
Ingredients:
1 pineapple, cup into chunks and frozen
1 cup of full fat coconut milk
2 Tbsp collagen (Great Lakes green label)
Directions:
Add it all to a high speed blender and go until it turns smooth and mimics soft serve ice cream!

How does an Autoimmune Disease Actually Happen?

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Without the audience having an in depth knowledge of the body, this can be a confusing process to explain.  However, I’m going to put on my teacher hat and try my best to explain how your body could ever be so confused that it begins to attack it’s own tissues resulting in diseases such as Multiple Sclerosis, Rheumatoid Arthritis, Crohn’s, Psoriasis, Hashimoto’s, etc.  Even though these diseases are present in different systems within the body, the same mechanism of trigger initiates the cascade.  Every autoimmune disease is an IMMUNE SYSTEM disorder.  However, most people focus on the system involved by taking thyroid medication for Hashimoto’s, creams for psoriasis, digestive aids for Crohn’s, and the list goes on.  Most of the heavy duty medications on the market for these problems are immunosuppressants.  That means their entire job is to dampen the ability of the immune system to function in hopes it will quit attacking itself.  This has a nasty side effect of also leaving patients vulnerable to sickness because their immune system is being shut down (hence the fine print in commercials saying not to take them if you are sick, in contact with the sick, etc.)  Many patients will say “Isn’t there a way to help this WITHOUT shutting down my immune system?!”  The answer is “absolutely,” but you will not find those methods in medication.  I hope now you are asking “HOW?!”  Let’s look at how it happens to try to address that question later…

Proteins: Proteins are the building blocks of life.  They are made up of things called amino acids and we use about 20 different amino acids to build every single kind of protein that we need.  Based on how you put the amino acids in sequence, you can create different kinds of proteins.  These creations make up the cells of your organs, your hormones, and the antibodies we call immunoglobins.  You may have heard of some of these amino acids without even knowing it!  We have all heard of tryptophan around Thanksgiving because people blame the sleepiness on it’s presence in turkey.  Maybe you’ve heard of Glutamine if you are in the fitness industry.  Perhaps phenylalanine has popped up as you search the risks of artificial sweeteners?  These amino acids are essentially the legos that make up parts of your structure.

Well, these proteins tend to have a lot of similarities to the proteins in other life forms such as animals, plants, and even viruses.  For heaven’s sake, we have 67% DNA similarity to an earth worm!  Like I’ve said before, this is why biological principles are important to know; we all exist under the same fundamentals!  Small sections of these proteins are recognized by antibodies.  This is the recognition system for our immune system to be able to ID, tag, and get rid of foreign invaders by recognizing specific amino acid sequences present on the protein structure.  When the antibody binds to one protein, it’s common that it will also attach to other proteins containing a similar sequence. This is a good thing if those other proteins are also foreign invaders, but it’s a bad thing if the other protein happens to be our own tissue.

Don’t worry though, we have a quality control system.  Because of so much shared DNA sequencing, this happens all the time!  It happens in everyone really.  However, we have a process called “selection,” that allows T and B cells to recognize self and they are destroyed.  This is all happening in the bone marrow and the thymus gland (hence T and B cells, haha…ok, not funny).   It can also happen via suppression where certain T cells shut down autoantibody production from any cells that may have escaped the first check.  In a healthy individual, this system of checks and balances works beautifully!  However, for those with autoimmune conditions, the body has a breakdown in the second process and simply can’t keep up with the quality control process of destruction.  Let’s just say your employee came in drunk and is no longer paying attention to the bad specimens rolling through!   So, it’s not really a problem with the body making antibodies against itself, because everyone does that.  It’s more about a faulty system in the ability to keep them at a minimum.

Once this breakdown occurs, it’s much easier for the body to then create another autoantibody to a different tissue, which is why so many autoimmune patients can then get another autoimmune disease fairly easily.  When enough damage has occurred to the tissue being targeted, you will start to express systems of the disease.  This is when you show up at the doctor with digestive distress due to Crohn’s, or unbearable joint pain due to Rheumatoid, or heaven forbid the neurologic symptoms of MS.  Here is where the fork in the road happens.  How do you treat it?  You can take medication to address the symptoms presenting, you can take an immunosuppressant to try and shut down your body’s ability to produce antibodies (to itself or to foreign invaders), or you can eliminate the triggers that cause the immune system to attack in the first place.

The environmental triggers for immune system attack can include anything from vitamin D deficiency, bacterial infections, silicone implants, chemical exposures, and yes, intestinal permeability (aka leaky gut).  Even though genes may create the perfect recipe for an autoimmune disease, the environmental triggers are really what start the cascade of events.  This is the reason why many people will say that genes load the gun, but lifestyle pulls the trigger.  This is why it is so important to be testing for underlying infections, nutrient deficiency, eliminating chemical exposure, and doing all we can to correct leaky gut.  If you correct intestinal permeability, you can reverse an autoimmune disease.  I have done this over and over with patients, and the changes in their quality of life and thought of such a different future makes me overwhelmed sometimes.  THERE IS ANOTHER WAY.  If you don’t believe that, then I can only imagine the thoughts that run through someone’s mind knowing it will only progress and get worse.  That part of my job breaks my heart.

The silver lining is that even though you can’t control your genes, you CAN control your lifestyle.  I will be writing a number of articles focusing on different aspects of this including the story of gluten, dairy, nightshades, and eggs in addition to the powerhouses I utilize with patients including ferments, broths, and organs.  I never know much to simplify my explanations to help someone understand the connection, so I have decided to go a little bit more in depth on the blog.  That way I have the easiest answer possible “Go take a look at the articles on the blog and let me know if you still have questions!”  For a professor, it’s like trying to teach 8 years of physiology in 30 seconds (because that’s how long you have until people tune you out if they aren’t understanding).  Good luck with that one!  I hope you enjoy, and if you have any questions you would like to make sure I touch on along the way, feel free to shoot me a comment!