Dr Liz Lipski, clinical nutritionist: focus on digestion and autoimmunity
If about thirty percent of the population have the right genes and everyone is eating gluten, why doesn’t everyone get a gluten related disorder (GRD)? Something has to trigger it. Dr Lipski cites parasites, stressful events, infections, an existing condition that encourages a leaky gut, a specific toxin or overload and meds, especially NSAIDs, as the main ones.
As you know, I am always trying to get people to think of leaky body barriers rather than just a leaky gut and Dr Lipski was the first person I ever heard who also said it: “When we have a leaky gut we often have leaky lungs or leaky skin or a leaky brain.” Spot on.
Lipski reminds us that two-thirds of our immune system resides in the gut and that this is our main interface between the external and internal world. The gut mucosal lining is only one cell thick and the cells replace themselves every 3-5 days. This takes an incredible amount of energy and she feels it may be that some people are just not keeping pace with the repair needs, which I thought was an excellent point.
She then focused on inflammation, which can trigger a leaky gut too. It doesn’t take much to trigger, she says, and malabsorption surely follows because, when inflamed, we make more intestinal mucous, making it harder for us to absorb nutrients.
People on processed, high sugar, GM and/or microwaved food diets can have higher than normal inflammation levels, leaky gut and low white blood cells which, she believes, results in lowered immunity against infection and the likelihood of increased inflammatory gut damage. She specifically advises against heating up formula or breast milk in a microwave.
In terms of treatment, Lipski follows the ‘DIG-IN’ multi-factorial approach including the right diet for up to 2 years (longer for some), a healing prescription using glutamine, quercetin, slippery elm, aloe and other elements, combined with stress relief and techniques to encourage healing such as acupuncture, hypnotherapy, CBT (cognitive behavioural therapy), meditation and Tai Chi. Happily, this is very much the same approach I have detailed in the Gluten Plan.
Diet-wise, she recommends grain free and lower carb gut-healing type diets like GAPs and SCD, which include fermented foods to support bacterial balance. She also recommends the identification and elimination of key food and environmental allergens. Cutting out the grains helps specifically, she feels, because it lowers the carbs that feed pathogenic microbes. She advises to watch levels of starchy veg for the same reason.
The D of ‘DIG-IN’ is all about digestion and absorption. Is there enough acid? Enzymes? How is bile flow?
I stands for intestinal permeability. In her view (and mine), leaky gut underlies many illnesses, including most autoimmune diseases, skin and inflammatory conditions.
The G refers to the gut microbiome. Up to four and a half pounds of microbes live in the digestive tract. They help regulate our metabolism and communicate with the food that we eat, giving self-signalling messages whether that food is actually good for us or not. They create all kinds of B vitamins and vitamin K, and secrete natural antibiotics and anti-cancer substances. This crucial microbiome is where the vast majority of our genes are – they help determine whether we’re fat or thin, healthy or unwell, how much energy we have and so on. For her, and for most of the other experts in fact, the microbiome is the real key to health.
The next I in ‘DIG-IN’ stands for inflammation and immunity. This is all about how we reduce inflammation and get the immune system to reset itself so that it’s more relaxed and at rest.
Finally, the N is for the nervous system. People forget that we make more nerve transmitters in our digestive system than we make in our brain, so we have to support the enteric nervous system too if we are to get well.
Key Practical Message
Try and identify and deal with your triggers. For treatment, follow the right diet and follow a multi-faceted approach that includes: repair the leaky barriers, strengthen mucosal immunity, get rid of pathogens like candida and infections, support digestion and absorption - specifically stomach acid, digestive enzymes and bile flow - rebalance the microbiome, lower inflammation and address any other food or chemical sensitivities. Just a bit to go at there then!
Dr Yehuda Shoenfeld, world authority on autoimmune disease and rheumatology
Dr Shoenfeld has huge experience – he is on the editorial board of no fewer than 40 journals, has published 1700 papers in respected journals like the Lancet, authored 25 textbooks and his work has been cited over 31,000 times. I was really pleased to have the opportunity to see what he had to say on the Summit!
In medicine, he explains, we use immune-suppressive and cytotoxic drugs to bring down the antibody levels in autoimmune disease (AID), which is a very strong treatment approach. However, it was discovered in 2003 that AID starts many years before symptoms show. Diagnosis is possible at that stage and this means that preventative steps can be taken then instead of waiting for the disease to develop. This is now his treatment focus. He is frustrated that we know the antibodies are there years before, maybe even up to a 40 year incubation period for certain types of AID, yet nothing is usually done.
He admits he was one of those clinicians and used to ignore the antibodies found. Now his advice to patients with the antibodies but no sign of the disease is that they should be monitored for a long time as they have a greater chance of developing the disease. He thinks it is unethical for us to ignore the antibodies and not tell the patient about them.
In terms of GRDs specifically, he finds gliadin antibodies crop up as the most prevalent with AID. If he sees it, he thinks a gluten free diet is a sensible approach as it could well be a trigger. Interestingly, he explains that the HLA genes (the ones found in GRDs and type 1 diabetes, for example) are ‘very prevalent’ in AID and people with them tend to present with worse cases than those without.
In terms of triggers, he mentions diet and lifestyle are key. Environmental triggers include bacteria and pathogens which can cause molecular mimicry and confuse the immune system. For example, it is well-accepted that treatment for H pylori can stop ITP (idiopathic thrombocytopenic purpura), a common AID. In essence, the H pylori antigens look structurally similar to some platelets and the body attacks the platelets instead of the bacteria. This is just one example. Others discussed included recurrent miscarriage (gluten and body phospholipids) and some types of cardiovascular disease.
Treatment-wise, not surprisingly, he advises looking at the known cross-reaction antigens and risk factors for the various autoimmune diseases, and doing something about them if found. He thinks that hyper-permeability and microbiome changes are probably a factor in AID, although the debate rages on, but giving probiotics should pretty much be a given in any treatment strategy.
Interestingly, he reports using high dose Vitamin D has proven a good way of lowering AID antibodies in some patients, although he didn’t elaborate on that; we shall have to look out no doubt for his paper on the subject!
Key Practical Message
Check autoimmune antibodies and don’t ignore them. Monitor any found, and take steps to lower them and therefore your risk of developing the related disease. Use probiotics, a healthy diet and lifestyle and ensure Vitamin D levels as part of the treatment strategy to lower AID risk factors.
To read the introduction to the Gluten Summit, see here. Catch up with the mini-series 1, 2, 3, 4 and 5. And to read the conclusion see here
For more from me and on gluten related disorders generally, see my TrulyGlutenFree site.
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