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?