Tuesday, July 6, 2010

Autoimmune Disease

The first thing you think of when the word "psychiatry" comes up is probably not autoimmune disease. But I see a lot of it, as autoimmune diseases (all kinds - lupus, MS, hypothyroidism, rheumatoid arthritis, asthma, seasonal allergies etc.) bring with them their tough to treat anxieties and depressions. And of course, as a psychiatrist, I'll also get referrals for people with vague symptom clusters of autoimmune-like illness who have been worked up for all sorts of dire things, and when nothing shows up on lab tests, they are shipped off to me. A few years ago, I actually helped write a book for these kinds of symptoms - Feeling Better: A 6-Week Mind-Body Program to Ease Your Chronic Symptoms, so I might get more of these kinds of referrals than the average psychiatrist. (Full disclosure - please ignore the nutrition chapter from the book, if you happen to pick it up! It's more Body For Life than Primal Blueprint!)

For today's post, I thought I might summarize Staffan Lindeberg's work from Food and Western Disease: Health and nutrition from an evolutionary perspective.

From the beginnings of the immune system, our ancestors have used it to fight off attacks strange-looking proteins. Autoimmune problems occur when our immune systems are somehow triggered to take on our own bodies.

How could this happen? Lindeberg suggests the following - start with an increased amount of potential antigens in the intestine from problematic foods, such as grains, milk, and beans. Cereals and beans also have enzyme inhibitors which keep our intestines from fully breaking them down. Then plant lectins in beans and grains open the tight junctions between the intestinal epithelial cells to allow the partially digested, undesirable molecules to pass through. Gliadin, a wheat protein, also activates zonulin signaling, which makes the intestine even more permeable. (Yummy). Heck, "even the permeability blood-brain barrier has been shown to increase with the consumption of wheat lectin." (page 211).

Speaking of wheat - gluten intolerance is an autoimmune disease. In celiac disease, the consumption of wheat and rye (gluten) causes the intestinal lining to be destroyed. It is genetic, but is generally cured by eliminating grains from the diet. Dermatitis herpetiformis is an autoimmune skin disease that is also caused by exposure to gluten, and there is a form of ataxia (difficulty moving due to problems with muscle coordination) that improves dramatically with the removal of gluten from the diet. Other studies have found people with headaches that went away with a gluten-free diet. I've already reviewed the data in schizophrenia.

In rheumatoid arthritis, many patients have anti-milk or anti-wheat antibodies, or both. Fasting has been shown to be helpful, and so have a Mediterranean-like diet and a gluten-free vegan diet that was low in omega6/omega 3 ratio.

Type I diabetes (caused by autoimmune destruction of certain cells in the pancreas) has a geographical distribution that is strongly related to the consumption of cows milk, both on a global level and regionally. The more milk consumed, the more type 1 diabetes is found in a particular area. Immigrants who move to a milk-consuming area start to get more type I diabetes than their relatives who live back in relatively milk-free areas (such as Japan). Beta casein A1 is probably the most likely milk protein candidate, as Iceland has cows who produce smaller amounts of beta casein A1, and their happy milk-drinking people tend to have less type I diabetes than you would expect. Wheat lectins have also been suspected of causing issues with diabetes - as in one study 19 of 23 children with new onset type I diabetes had anti-wheat gluten protein fragment antibodies. Perhaps the wheat lectins open the gut, then the beta casein A1 gets into the bloodstream and triggers the autoimmune attack.

Multiple sclerosis has nearly an identical geographic distribution to type I diabetes, and many people with MS are found to have immune reactions to milk proteins. Wheat gluten antibodies are also increased among MS patients.

Lindeberg suggests, in summary, that there is plenty of evidence that problematic proteins in our food cause autoimmune reactions. Therefore, a trial of a Paleolithic diet for preventing and treating these illnesses is certainly reasonable. If your autoimmune disease is active, he says, reduce the amount of circulating proteins that are contributing to the problem. Don't eat cereals (including wheat), milk products, or beans. Make sure your gut is digesting properly by not eating protease inhibitors such as those found in cereals, beans, and soy. And keep your tight junctions in your gut happy and tight! Eliminate powerful lectins from grains, soy, legumes, and beans.

Sound familiar?

13 comments:

  1. So much for having Wheaties in skim milk for breakfast. Robb Wolf says that once you have autoimmune issues, even eggs and nightshades (potatoes, tomatoes, eggplant, peppers) can be problematic. So there goes spaghetti in tomato sauce! Pop tarts are still okay, right? Please don't take away my pop tarts!

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  2. interesting. i recently discovered that my chronic fatigue and other symptoms were mainly caused by dairy and gluten. then i changed my nutrition, partially by introducing eggs and tomatos, and now i begin to notice sensitivities to those as well. the same for some nuts, fruits and carrots. it's a bit depressing.. at the end there really is almost nothing left than meat some veggies. and coconut.. lol

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  3. While I'm not aware of much data as to the effect of the other lectins in nightshades, etc., it does follow logically that a trial elimination might benefit some. At least other lectins (but not wheat gluten or beta casein A1) can be reduced/eliminated with pressure cooking (beans) or proper preparation or soaking (nuts). I think something like ghee would also be safe. There is also the "two-hit" idea that if you've abstained from the creepiest lectins for a good long while (some people will say 3 months, others 6), your gut is healed, and then you can introduce other foods, as long as you stay away from the worst inflammatory ones (wheat, soy). It is tough with autoimmune issues, though. Just a small amount of antigen, theoretically, can wreak real havoc.

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  4. The nightshades can certainly be problematic for some (seems to be those with the leakiest of guts). My coeliac patients really struggle with potatoes and to a lesser degree tomatoes and peppers. Eggs can also exert some influence on leaky gut. The key is to learning what your individual tolerance is and to spread the antigenic load. So you might need to bulk your diet up on foods with a load reactive load, and then rotate some of the other things over an extended timeframe so that you can still enjoy those foods without them ripping your gut to bits. This should dampen down your immune system so it stops reacting to just anything it sees. You might want to really up the ante on fish oil and vit D supplementation (and maybe probiotics).

    My coeliac's swear by this Australian/New Zealand product in maintaining gut integrity and reducing intolerance to peripheral foods:
    http://fit-bioceuticals.co.nz/product.aspx?function=displayproduct&productid=130

    Have a look at some of Prof Loren Cordains research for more info on the potential issues with nightshades.

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  5. There is no question as to the leakiness of the gut in celiac dx and newborns and UC, but other guts may not be so leaky. I think the most telling thing I learned from Lindeberg is that perfectly functional tight junctions will still allow the wheat lectins through. Is the same true of the nightshades? I honestly don't know.

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  6. Interesting...I wish more doctors were aware of this information so that they could encourage their patients to at least try changing their diet to see if it would help...

    Also any suggestions for increasing omega 3 if you can't take supplements of any kind and don't like fish? I'm guessing "start liking fish" is my answer... :-)

    So are some people just more predisposed to autoimmune issues than others? For example, I have AI issues and have had minor ones all my life (none listed here...) and my husband has none at all and we eat the same diet essentially. Big difference is weight - his is fine, mine is higher...

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  7. Yes, some people are just more vulnerable. If you don't like fish and can't take supplements, you can more seriously avoid sources of omega 6 - nuts, poultry fat, and vegetable oils. Grassfed beef and bison have a fairly nice balanced O3:06. I would say from my reading that it would be nearly impossible to be deficient in 06, but it is very easy to miss out on the 03. You could compromise - for every chicken leg, a cut of fish?

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  8. Nice blog. I just recently discovered it. I´m from Iceland and I have read about the A1 and A2 difference in cow´s milk. I had been wondering about what type of milk is in Iceland but didn´t really know where to look for that information. Unexpectedly, you mention it on this blog. But where did you get this information, I would like to see it for myself if possible.

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  9. Hi Anna - thanks for your comment. I got that info from Food and Western Disease page 73, specifically. Checking Dr. Lindeberg's references - looks like he got the info from 1) Elliot et al type 1 diabetes mellitus and cow milk. Casein variant consumption. diabetologia 42, 292-6 (1999). 2) Lien et al. Comparison of milk protein allele frequencies in Nordic cattle breeds. Anim Genet 30, 85-91. (1999). 3) Thorsdottir et al. Different beta-casein fractions in Icelandic versus Scandanavian cow's milk may influence diabetetogenticity of cow's milk in infancy and explain low incidence of insulin dependent diabetes mellitus in Iceland. Pediatrics. 106, 719-24 (2000).

    Hope that helps!

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  10. Thank you so much, I know now where to find the last article, so it was very helpful. I will look into it when I have the opportunity.

    Because of one study from Iceland I had guessed that the icelandic milk wasn´t all bad since the life span of people with certain mutation decreased with less dairy consumption. But of course that was around the same time sugar and wheat was introduced into the diet. You can see it here if you are interested.

    http://www.keldur.is/en/en/hereditary_cystatin_c_amyloid_angiopathy

    http://hirsla.lsh.is/lsh/bitstream/2336/30310/1/P2008-F1.pdf

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  11. That's very interesting. A concrete demonstration of the concept that diseases aren't necessarily genetic - just genetic with respect to vulnerability to something ubiquitous in the enviornment. Wow.

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  12. Fascinating. I've been researching everything I can on this lectin issue, since I have RA. I've been on no grains, beans or nightshade whatsoever for five weeks and my pain and swelling are markedly improved. Hoping that's a trend!Have you discovered anything more in this area since this post?

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  13. I have had very good results in patients with both RA and psoriasis who have been able to restrict wheat and dairy in their diet.

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