Disease 202 Flashcards
The perfect storm of four factors often involved in chronic autoimmune activation includes:
● Genetic or Familial predisposition. This may affect the disease process via a number of different avenues e.g. impaired detoxification, modified immune response, early life trauma, higher sensitivity to specific environmental agents, increased formation of inflammatory mediators.
● Environmental trigger(s). This might include toxins/chemicals, pathogenic microbes, inflammatory foods, and/or high emotional stress.
● Intestinal permeability. IP allows the immune system to be more heavily exposure to microbial DNA and also allows the human DNA to be more heavily exposed to microbes, toxins, and potentially inflammatory substances (e.g. food) from the gut. Individuals with autoimmune activation are more likely to experience a higher secretion of zonulin in response to gluten intake, which promotes intestinal permeability. Other factors such as insufficient Vitamin D, medications, antibiotics, and ongoing NSAID intake may also be involved.
● Weak, insufficient, or imbalanced immune function. This may be due to factors such as nutritional deficiencies (e.g. Vitamin D, Vitamin A, zinc), stress, pathogen overload/dominance, and/or toxicity.
According to published research, 77% of patients with a Fibromyalgia diagnosis and 92% of those with a Chronic Fatigue Syndrome diagnosis test positive for
SIBO (small intestinal bacterial overgrowth), that is an overgrowth of bacteria in the small intestines which are normally endemic to the colon. Other microbial imbalance may also be present.
Overall, approximately ___% of autoimmune disease activation is attributed to genes, that is to genetic predisposition.
30%
People with chronic autoimmune activation may have an exacerbated disease process from dysregulated, internal inflammation management caused by low levels of the hormone:
Cortisol. This may be caused by a combination of ongoing mental-emotional stress and physiological stress (e.g. food sensitivities, toxins, simmering infections, poor nutrition). Remember that a multi-sample, salivary test is usually the best, accessible way to understand explicitly when and to what degree a person’s daily cortisol cycling is impaired.
In chronic autoimmune activation, Tracy’s analogy of the immune system being like a “cornered, wounded animal” means that the immune system is _____________ and ________________
● Overwrought meaning the immune system (adaptive or innate) can be aggressively activated but in an inappropriate and imbalanced way, especially in regard to high antibody development to benign substances (e.g. everyday foods). Obviously, antibodies to self (normal, expected human tissues) is already an example of this. In some cases, the immune system has been confused by molecular mimicry and is attacking a non-threatening molecule (e.g. a food) that appears similar to something truly threatening (e.g. bacteria).
● Weak meaning suboptimally effective. Since so much of autoimmune dynamics takes place in the gut, insufficient levels of key immune-building nutrients due to malabsorption may be a major factor (e.g. zinc, Vitamin A, copper). Vitamin D level is critically important for avoiding or overcoming autoimmune activation. Overall white blood cell (WBC) count may be impaired due to extended immune system activation that depletes the body’s supply of WBCs, especially toward a simmering infection. Toxicity may also impair WBC formation.
A specific type of white blood cells called _________ may be suboptimally low in those with chronic autoimmune activation.
These cells help to keep T cells from becoming overzealous and attacking self tissues.
T-Regulatory Cells
These cells help to keep T cells from becoming overzealous and attacking self-tissues. Despite earlier misunderstandings, it is now clear that dysregulation of both B and T cells is often involved in autoimmune activation. Recent research has shown that the level of short-chain fatty acids (SCFAs) generated by microbes in the gut plays a large role in promoting the formation of optimal numbers of T-regulatory cells. This is yet another example of how the human immune system is highly influenced by the health of microbes in the intestines. SCFAs can be measured in a comprehensive stool test, and generally SCFAs are increased by higher levels of endemic, facultative intestinal bacteria and higher intake of prebiotic foods to nourish them. SCFAs are a normal metabolic byproduct of bacterial fermentation.
All clients/patients with chronic autoimmune activation should eliminate ________ from their diet in order to prevent further damage to the critical barrier function in the intestinal lining.
Gluten
In addition to eliminating gluten, I encourage all my clients with chronic AI to pursue a food sensitivity test. In the absence of testing, I usually recommend 100% elimination of dairy and also often all grains (to avoid exacerbating many, common gluten cross-reactive sensitivities and also any yeast/fungal overgrowth).
____________ is a specific probiotic you have learned about in your SAFM coursework that has been shown to increase SCFAs in order to boost immune strength in the gut. It can be particularly helpful in modulating the immune system away from autoimmune activity in inflammatory bowel disease (e.g. ulcerative colitis). It is also particularly helpful in avoiding antibiotic-associated diarrhea and preventing pathogen bacterial infection (e.g. C. Diff) as a result of antibiotic use. _____________ is one specific situation in which this particular probiotic would be contraindicated.
Sacharamyces Boulardi
A known food allergy or sensitivity to yeast
Gut healing is a key part of chronic autoimmune support. Supplementation with a key amino acid, ________________, can help to repair damaged intestinal villi. This amino acid is the primary metabolic fuel for the enterocyte cells that line the intestines. Other key agents that can help to repair intestinal permeability and nurture the intestinal lining include __________ and _______________ .
L-glutamine
Quercetin, Vitamin D, Aloe vera, slippery elm, okra, zinc, carnosine, marshmallow herb, and deglycyrrhizinated licorice (DGL).
Many people with chronic autoimmune activation have reduced secretion of _________________ from the pancreas and may thus struggle with suboptimal levels of key nutrients.
Digestive Enzymes
This is because microbial imbalance in the gut (common in chronic AI dis-ease) can interfere with optimal hormone secretion in the brush border of the intestines (e.g. CCK, or cholecystokinin). CCK stimulates the release of enzymes from the pancreas and bile from the gallbladder. In particular, this combination can impair fatty acid (and fat-soluble vitamin) digestion and absorption and increase fecal fat excretion (with may contribute to flatulence and loose stools). Short-term support with digestive enzyme supplements may help to maximize nutrition in these clients/patients.
Clients/patients who consistently consume a vegetarian or vegan diet are particularly likely to have insufficient levels of ________________, a key mineral involved in immune system strength. This mineral also competes for absorption (at the gut and the cellular level) with ________________, a mineral typically quite high in these diets.
Zinc
Copper
Consuming zinc in supplement form can help the body to excrete excess amount of copper.
The process by which the immune system can become dysregulated and begin to attack self-tissue by perceiving a self (benign) substance is actually a known dangerous one (e.g. bacteria) is called:
is called molecular mimicry. Because of similar molecular patterns, clinical research is beginning to understand some of the more common forms of molecular mimicry that can lead to specific autoimmune disease activations (e.g. Rheumatoid arthritis and Proteus or Candida or Mycoplasma).
There are many lifestyle choices and circumstances which can contribute to downstream dis-ease beginning in the gut. At the level of physiology in the GI tract itself, list 5 relatively common mechanisms via which dis-ease can begin in the gut that you learned in your SAFM coursework.*
(Do not include lifestyle choices/impact but rather the downstream mechanism of dysfunction that they promote in the gut.)
● Poor diet yields low exposure to key nutrients the body needs to maximize all its functions.
● Low stomach acid impairs the body’s ability to absorb key minerals (e.g. Mg, Zn, Fe), Vitamin B12, and/or key amino acids (e.g. tyrosine needed to make thyroid hormone or to produce the neurotransmitters dopamine, epinephrine, and norepinephrine). Low stomach acid might be precipitated by many different factors (usually a combination of multiple ones) e.g. age, acid-suppressing drugs (e.g. PPIs), food sensitivities, poor eating hygiene, H Pylori overgrowth in the stomach, chronic stress, or low thyroid function.
*Please note that the formula used at the time is now being sold under a different name, Visbiome. The product currently called “VSL#3” in the marketplace may be different from the one that was actually used in this case and the one that was used in the original studies demonstrating efficacy.
●Ongoing intake of NSAIDs damages and thus impairs the function of the intestinal lining, leading to malabsorption of nutrients.
●Ongoing stress and operating in a sympathetic nervous system mode impairs optimal secretion of digestive fluids (e.g. enzymes, bile, stomach acid) leading to maldigestion of food and thus malnutrition.
●Chronic constipation impairs detoxification and the body’s ability to rid itself of toxins prepared for excretion. These toxins may then be reabsorbed into the body via the colon.
●Repeated intake of substances that imbalance or decimate gut microbes causing immune system imbalance or dysregulation or chronic inflammation (e.g. antibiotics, oral birth control pills, antidepressants e.g. SSRIs, artificial sweetener sucralose, chlorinated municipal water).
●Pathogenic microbial overgrowth in the gut (e.g. parasite, yeast/Candida, Klebsiella or other bacteria) can cause chronic inflammation.
●Grazing on food all throughout the day – leading to impaired cleansing waves
in the intestines - can lead to microbial imbalance or an overgrowth of
pathogenic microbes.
●Small intestinal bacterial overgrowth (SIBO) that drives the intestinal production of serotonin unnaturally high or low, often causing IBS-like symptoms (e.g. cramping, bloating, persistent diarrhea or constipation (or an alternating pattern of both)).
●Intestinal permeability may create food sensitivities and/or expose the immune system to microbes and/or their waste products/toxins, both being potential sources of chronic inflammation.
●Diarrhea can cause dehydration and impair key nutrient absorption (e.g. magnesium or essential fats) due to fast transit time and overly stimulated
motility
●Insufficient or sluggish bile output from the liver and gallbladder (or in some cases lack of a gallbladder) can impair the body’s ability to emulsify and thus
digest and absorb essential fats (e.g. omega-3s like EPA/DHA or the essential omega-6 GLA) and fat-soluble vitamins (e.g. A, D, E)
