If so, you could be denying your gut wall the opportunity to repair
– and your immune system the chance to thrive
The aim of this blog is to empower everyone to think differently if they are challenged with an autoimmune condition.
The immune system protects you against foreign invaders and helps your body to heal and repair. Autoimmunity is when the body starts attacking itself. This happens when larger molecules leak through the gut wall. The following can damage the gut wall leading to leaky bowel syndrome:
- An inflammatory western diet of high sugar and highly processed refined carbohydrates
- Personal hypersensitivity to gluten, dairy, soy, eggs or peanuts
- When your gut becomes colonised by pathogenic bacteria, producing toxins that damage the gut wall
A leaky bowel allows larger, not fully digested molecules to leak through. This irritates the 80% of the immune system that resides on the other side of the gut wall. Then, guided by molecular mimicry or other mechanisms, the immune system can progress to launch attacks against the body’s organs such as the thyroid or joints, leading to autoimmunity.
The standard treatment for autoimmunity is either steroids alone or a combination of steroids and cytotoxic drugs, to suppress the immune system, aiming to reduce or stop the organ damage.
However, having a suppressed immune system can put the patients at risk of a serious infection. The problem is now compounded by challenging infections around, such as Covid-19.
This is a 55-year-old lady went on a long holiday to Pakistan. She was shocked to find her sister had been diagnosed with cancer. She stayed in a big house, where the second floor was uninhabited and regularly visited by bats. While she was there, she helped by looking after her sister’s chickens. She also indulged in the delicious local sweets.
Towards the end of her holiday, in November, she developed mouth blisters and ulcers. She returned to the UK early in December and the condition progressed to blisters all over her body. Then early in January, whilst in Saudi Arabia, she felt unwell and was prescribed a course of antibiotics.
Pemphigus vulgaris (a skin condition) was confirmed by skin and mouth mucous membrane biopsies, and she was prescribed 20 mg prednisolone and 75 mg Azathioprine daily, long-term antibiotics, skin creams, mouth wash and bone protection.
However, she continued to have a sore throat, with a painful mouth ulcer making it harder for her to eat. She also suffered significant hair loss during brushing, she was found to have iron deficiency and started iron therapy. She then experienced remission of mouth and skin blisters and ulcers while fasting during Ramadan. She kept to a diet mainly of chapati (wheat) and curry (vegetable oils), low in fruits and vegetables.
Lots of drugs – and more drugs to counteract those drugs!
She started on steroids (Prednisolone 25 mg orally) plus cytotoxic drugs (Azathioprine 75 mg daily), and, to reduce their side-effects, she was given Omeprazole 20 m daily (to reduce stomach acid to prevent ulceration and bleeding), Adcal D3 one tablet twice daily plus Alendronic acid 70 mg weekly (to prevent osteoporosis), and an antibiotic (Doxycycline) to prevent a flare up of inflection.
But the condition got worse – the lesions were not healing, and were giving her a stinging sensation, with the skin becoming very itchy, painful and stiff.
She reattended the dermatology clinic, with the result that the steroid and cytotoxic drug doses were doubled. Unfortunately, this resulted in liver damage. Her family were very concerned about the whole issue and requested an urgent appointment at The Vitality Clinic.
My examination revealed eight silver dental fillings. The patient was slightly overweight (63 kg), with a BMI of 26.0, and most of this weight was around the middle – waist 37 inches, hips 40 inches, giving a waist/hip ratio of 0.92. She had normal vital signs, with a pulse of 66 and blood pressure 130/90.
She was pale and her iron level was low at 6.3. Her HbA1C was very high at 47, indicating steroid induced diabetes. A stool test reported high normal bacteria – Enterobacter, Bacteroidetes and Firmicutes – likely due to low stomach acid, high growth of bad pathogenic bacteria (dysbiosis) – Bacillus, Pseudomonas, Staphylococcus aureus – and heavy growth of the yeast, candida albicans.
Tests also confirmed poor intestinal health – low pancreatic elastase1 (probably related to stress) and low secretory IgA (the immune globulin that protects the mucus membranes.)
In summary, she had high pathogenic bacteria, high normal bacteria and high candida. She had low digestive function, probably related to ongoing stress. There was confirmed gluten, milk and dairy sensitivity. She had a high tendency for immune system overactivity. And she had steroid-induced diabetes (HbA1C 47.)
The patient presented with a complex clinical picture, which required a lot of careful thought to avoid more damage. We devised the following plan to restore gut health. We gave her Rifaximin, which is an antibiotic, non-absorbable acts locally in the gut, strong enough to rid the gut of the bad pathogenic bacteria, but gentle enough to support beneficial bacteria. It is expensive but deemed cost-effective in this case, as there was no other antibiotic that could perform this delicate job.
I also chose Caprylic acid (a natural component of coconut oil), which is unique in its ability to bring candida numbers down to normal level, with no significant side effects.
In addition, I recommended bone broth, glutamine and cabbage soup to seal the gut wall, as well as a high fibre diet, Butyrate and MCT oil to nourish the wall, and amino acid powder to support nutrition, together with other vitamins and mineral supplements.
(We also prepared a plan B in case this did not work. This involved a faecal microbiota transplant.)
We also had to calm the immune system
In view of the genetic test reporting multiple pro-inflammatory genes, including IL-6 variant, giving her immune system the tendency to overreact, I also prescribed a Low Dose Naltrexone (LDN) to calm the immune system. LDN shows great results in patients with autoimmune disease, such as rheumatoid arthritis, lupus, inflammatory bowel disease and other conditions.
Toping up beneficial bacteria would enhance recovery
Our patient had experienced severe stress – this will have had an immediate impact on the gut wall and the microbiome population. Studies show that stress wipes out the big tribes of beneficial bacteria such as lactobacillus, acidophilus and bifidobacterial.
We therefore decided to populate the gut with good bacteria while killing the bad bugs in the process. This meant introducing probiotics at the same time as the patient was taking antibiotics and the natural antimicrobial agent. This is doable but you must keep a gap of 2 to 3 hours between the antibiotics and probiotics, so that they do not cancel each other out.
What role does intermittent fasting play?
You cannot repair the gut while it’s working 24/7. Downtime is essential for the gut to heal and repair. We used to eat three meals a day with no snacking in between, and nothing from dinner until breakfast the next day. This regime at least gave the gut 12 hours’ downtime in every 24.
Snacks have only really been around since the late 1970s, resulting in ill health and diseases from obesity, metabolic syndrome to allergies and autoimmunity.
I normally advise people to start building their fasting gradually, aiming for an eventual 16 hours’ fast, leaving an 8-hour eating window. It is very important to understand that we are only restricting the time of eating, not the quantity of food. You can eat as much healthy food as you want within the timeframe.
This will not only allow the gut to heal but will also improve your general health more than any other medical intervention.
Unfortunately, I keep seeing the autoimmunity pattern repeated in many patients attending the clinic – high bad bacteria or yeast, low good bacteria, low digestive function, low mucous membrane protective secretory IgA, and a genetic tendency for the immune system to overreact.
This 35-year-old gentleman is a roofer, experiencing minor patches of psoriasis since he was 25, using topical skin preparation, as required. His condition deteriorated with extensive patches on the chest, arms and legs, and illness characterised by eggy burps and diarrhoea for few months.
Smoking, drinking, roofing
He attended hospital after an episode of blood in his stool. Clinical assessment could not find any abnormality, but he was advised further investigation with a colonoscopy.
He had brittle, pitted fingers and toenails with white spots. These were associated with mild joint stiffness in the morning but no overt arthritis. He had been born prematurely (32 weeks), had cradle scalp early in life, and was bottle-fed a cow milk formula as a baby.
His diarrhoea has changed to constipation since he went on a healthy diet of green salads and vegetable juice. His bowel currently opens once every 2 to 3 days. His energy level fluctuates with meals and he usually experiences, a big energy dip in the afternoon. He has been exposed to heavy metals (mercury, lead) working in the roofing industry for eight years. He has been smoking since the age of 15.
A specialised stool test revealed high faecal fat and normal pancreatic enzymes, which means he is not digesting or absorbing fat due to low bile flow. He has low beneficial bacteria – low lactobacillus 1+, low Bifidobacterium 1+.
He has high pathogenic bacteria, most of them known to produce a toxin (LPS) that breaks the tight junctions of the gut and causes leaky bowel. He also has low total short chain fatty acids (SCFA), and low butyrate – these are necessary for healing the gut.
A genetic test showed high inflammatory genes, showing a tendency for an overactive immune system.
The patient’s condition improved greatly on an elimination diet of real food together with active nutrients to support bodily function and detoxification and natural antimicrobial agents. He also pursued the 8/16-hour intermittent fasting regime.
He is happy to report the disappearance of most of the psoriatic patches on his chest and legs, and he now has the energy to go running, and is confident enough in his skin condition to wear just vest and shorts. He does not experience stiffness or arthritis in the small joints of the hands or feet or large joints. He enjoys greater energy throughout the day with no afternoon dip. He is working hard to improve his lifestyle, particularly in relation to smoking and binge drinking.
Unfortunately, these cases are repeated many times in the patients who visit my clinic. And it makes me worry if modern life – being stressful, sedentary and especially snack-filled – is producing an autoimmune pandemic.
What do you think?
Please, my friends, do share any experiences that you have had similar to those discussed above. Your challenges, and how you dealt with them, may help others who are facing the same, because, believe me, with an autoimmune condition, you are certainly not alone!