The bacterial balance in the intestine and how this may predispose to autoimmune disorders. The effects of different diets on bacteria in the intestine.
In Celiac Disease the HLA-DQ2 and/or DQ8 genes are necessary, but not sufficient for the development of the disease…. What additional factors drive this epidemic?
a. Quantity and Quality of gluten (Accounts for 20% of human calorie consumption)
b. Less breastfeeding, More C-sections
c. Timing of gluten introduction — (the later the better.)
d. Gut integrity (leaky gut, mucous production, maturity of immune system)
e. Microbiota balance in the gut
What about the Microbiota of the gut? The Microbiota is a population of bacteria, yeast and other tiny organisms. Lets talk about how they affect your immune system.
Wow…an estimated 75% of the immune cells in the human body are found in the GI tract. (1) This is a major influence on how the rest of your immune system reacts. The immune cells in your lungs know…any microbe is the enemy. But in the gut, the immune system must decide, is this a friend or a foe? The intestinal microbiota has a critical role in development of immunity. It can also protect from pathogenic bacteria directly by preventing their attachment, as well as outcompeting them for nutrients, and maintaining pH.
During vaginal delivery, the infant is exposed to its first dose of probiotics as it swallows the fluids in the birth canal. Cesarean Delivery increases chances of developing celiac disease with a 1.8 odds ratio (2)
A correlation has been found between intestinal bacterial balance and development of autoimmune diseases. Examples of associations between GI microbes and autoimmune disease:
- Klebsiella: Ankylosing Spondylitis
- Citrobacter, Klebsiella, Proteus Rheumatoid Arthritis
- Yersinia: Grave’s Disease & Hashimoto’s Disease
- S. Pyogenes: Rheumatic Fever
- Camphylobacter jejuni: Gullian Barre Syndrome (3)
The following slide shows the similar structure between Proteus and host protein.
Some studies have found that celiac patients have different fecal microbiota from the general population. This may correlate with the fact that celiac patients have approximately 10 times the rate of auto-immune thyroid diseases, such as Hashimoto’s thyroiditis and Grave’s disease, as non-celiac individuals (4)
Microbiota may play a role in other diseases, as well. Clostridium coccoides produce short chain fatty acids. Some short chain fatty acids, such as propionic acid, are helpful in low quantities, but neurotoxic in high quantities and may contribute to the development of Autism symptoms (6,7). Diet and its effects on the Microbiota have been linked with depression (8,9)
If an imbalance in the microbiota is harmful, how can I impact the balance the most? Most people would say to take a probiotic. But, if you aren’t feeding a probiotic the right food, it may not help. I would say a probiotic is important, but so is diet. ~60% of gut microbiota variability can be attributed to food.
How does diet affect the gut? Lets look at the first food humans receive. Breast fed infants have higher levels of Bifidobacteria spp. while formula fed infants have higher levels of Bacteroides spp., as well as increased Clostridium coccoides and Lactobacillus spp. (5) The following chart shows the affect of different diets on Bacteria.
A gluten-free diet decreases the number of Firmicutes and increases the quantity of Proteobacteria. In celiac individuals this may cause a reduced immune response. A gluten-free diet may not completely restore the microbial balance. Administration of Lactobacillus casei has been found to be effective in restoring the mucous layer and lymph integrity in a mouse model of celiac (10-13).
Probiotics in small doses (1-2 million) are not enough to even make a drop in the bucket. There are 10 trillion cells in your body and about 100 trillion microbes in your intestines. It takes consistent dosing of acid-resistant strains. I recommend 20-40 billion bacteria per dose at least.
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2. Decker et al. C-Section Delivery and Increased Risk of Celiac Disease Pediatrics 2010;125:1433-40.
3. Mayes MD. Epidemiologic studies of environmental agents and systemic autoimmune diseases. Environ health perspect. 1999; 107 (suppl 5): 743-748
4. Ansaldi N et al, Autoimmune thyroid disease and celiac disease in children (Abstract), J Pediatr Gastroenterol Nutr, Vol. 37, No. 1, pp. 63-66
5. Fallani, M.; Young, D.; Scott, J.; Norin, E.; Amarri, S.; Adam, R.; Aguilera, M.; Khanna, S.; Gil, A.; Edwards, C.A.; et al. Intestinal microbiota of 6-week-old infants across europe: Geographic influence beyond delivery mode, breast-feeding, and antibiotics. J. Pediatr. Gastroenterol. Nutr. 2010, 51, 77–84.
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10. Nistal, E.; Caminero, A.; Vivas, S.; Ruiz de Morales, J.M.; Saenz de Miera, L.E.; Rodriguez-Aparicio, L.B.; Casqueiro, J. Differences in faecal bacteria populations and faecal bacteria metabolism in healthy adults and celiac disease patients. Biochimie 2012, 94, 1724–1729.
11. Di Cagno, R.; de Angelis, M.; de Pasquale, I.; Ndagijimana, M.; Vernocchi, P.; Ricciuti, P.; Gagliardi, F.; Laghi, L.; Crecchio, C.; Guerzoni, M.E.; et al. Duodenal and faecal microbiota of celiac children: Molecular, phenotype and metabolome characterization. BMC Microbiol. 2011, 11, doi:10.1186/1471-2180-11-219.
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20. Brown, K et al. Diet-Induced Dysbiosis of the Intestinal Microbiota and the Effects on Immunity and Disease Nutrients 2012, 4, 1095-1119; doi:10.3390/nu4081095