Autoimmune diseases like rheumatoid arthritis, Hashimoto’s, multiple sclerosis, inflammatory bowel diseases, lupus and celiac disease are on a significant upward trend in the United States today. Autoimmunity is a misdirected immune response that happens when the immune system attacks itself. For example, in Hashimoto’s disease, the immune system attacks the thyroid. Therefore, the presence of an autoimmune condition indicates that we need to focus on correctly directing the immune system.

Conventional medicine treats autoimmune conditions by using medication to inhibit symptoms. However, a huge piece of the puzzle is missing, one that is a root cause of many conditions: gut health. With 70 percent of the immune system located in the gut, it is important to focus on the role of gut health in autoimmunity. According to renowned researcher Dr. Alessio Fasano, there is a “three-legged stool of autoimmunity,” meaning three factors need to be present for autoimmunity to develop: 1) genetic predisposition; 2) a trigger; and 3) intestinal permeability. These three factors together create the ideal environment for autoimmunity to develop. Eliminating or repairing intestinal permeability can lead to potential improvement or even remission of autoimmunity.

Research shows that gut dysbiosis, an imbalance of good and bad bacteria, is a contributor to autoimmune conditions, and specific bad bacteria in the gut can directly trigger an autoimmune reaction. What people may consider normal—acid reflux, bloating, not going to the bathroom everyday (less than one bowel movement per day)— are actually signs that the gut is out of balance and must be addressed.

Diet and lifestyle are the largest factors that can help or harm our bacterial balance. The factors that negatively contribute the most to microbiome disruption include high intake of processed foods, refined sugars, hydrogenated/trans fats, overuse of antibiotics or acid blockers, stress, smoking and alcohol. However, even the healthiest eater can have a significantly imbalanced gut.

A good balance of bacteria can be supported by consuming a diet rich in colorful fruits and vegetables, stress reduction, smoking cessation and avoiding unnecessary medication. Another strategy is to consume probiotics, which are live beneficial bacteria. They can be an excellent addition to a supplement routine or easily consumed through fermented foods, such as kefir, kombucha, kimchi and sauerkraut. However, for some, probiotics may exacerbate certain conditions. Thus, when adding or subtracting foods and/or supplements for gut health, personalization is absolutely key.

Similarly, probiotic supplements should be individualized as well. Prebiotics, substances that feed bacteria and are, in a sense, precursors to probiotics, are also a worthwhile addition for many people. Onions, garlic and asparagus are examples of prebiotics. At the same time, if someone ingests these and it causes any GI upset, it may indicate that the prebiotics are feeding bad bacteria.

For those with autoimmune conditions, or even for prevention, a comprehensive stool test is the optimal way to determine best steps for moving forward with gut health. By simply evaluating symptoms, it is hard to know where to start. Add probiotics? Remove gluten? Add anti-inflammatory support? The stool test gives us a road map about the current state of the gut and how to proceed.

Another marker of gut health called zonulin, can be evaluated when determining any food sensitivities. Zonulin is a protein that is responsible for controlling the gut’s permeability. Specifically, it has the power to disassemble the tight junctions that keep a gut in intact, making sure undesirable proteins do not get through to the bloodstream. However, when gluten or other potential inflammatory foods or proteins are ingested, zonulin is released and tight junctions become loosened allowing the protein’s access to the bloodstream. This sets off the entire inflammatory and immune cascade. As a result, other food proteins that may have previously caused no problem and may even be anti-inflammatory could then cause a similar immune reaction, becoming labeled as additional food sensitivities.

The food groups most implicated in worsening autoimmune conditions include gluten, dairy, sugar, eggs and nightshades. Additionally, targeted supplements that include glutamine, an amino acid that fuels the intestines, or other gut healing nutrients may be helpful to add in.

Each person should seek a healthcare practitioner that will take an individual approach to managing, improving or preventing an autoimmune condition. With extensive nutrition and biochemistry education, functional dietitians are ideally suited to guide and support individuals with diet and lifestyle changes that may prevent or improve symptoms associated with autoimmune conditions.

Bridgitte Carroll, MS, RDN, LDN, is an integrative and functional dietitian in Waltham. She works one-on-one with clients utilizing a systems approach to get to the root cause of bodily imbalances. She is currently accepting new clients and accepts insurance at Johnson Compounding and Wellness. To schedule a consult, visit Calendly.com/Bridgitte-Carroll. S