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Guest Post by Angie Alt: How Getting Sick Made Me Passionate About Dirt

April 22, 2013 in Living with Autoimmune Disease

Angie AltAngie Alt is wife, mother, world traveler & blogger. She’s also a warrior in the autoimmunity war. Angie confronts three autoimmune disorders each day, including Celiac Disease, with powerful management techniques like AIPaleo & the Paleolithic lifestyle. She blogs regularly about the emotional side of tackling autoimmunity, adopting Paleo, and how it impacts her, her family, & their way of life. You can read more by Angela Alt at her blog and connect with her on Facebook.

I’ve been writing regularly for The Paleo Mom for a while now and in a few short weeks I will celebrate my first Paleo-versary.  All that time I’ve been slowly healing, learning, and growing as a person.  Along with my first few years as a parent and my time living in West Africa, this past year has been one of the most dramatic periods of personal growth in my life.  The road from illness to health has deeply impacted my values . . . I’d go as far as saying that being sick with autoimmunity made me passionate about dirt.

 It started with illness itself.  I was deep in it.  Deep, deep.  Long nights in lonely hospital beds on three separate continents, hours upon hours in overburdened ERs, protracted, solitary waits in doctor’s offices . . . I had a lot of time to think.  Naturally, I thought about illness, not just my own illness.  I thought about why so many of us have gotten sick and why we can’t seem to get well.  It did not take me long to understand that our “healthcare system” was more like a “sick care system.”

 When I got a diagnosis, Celiac Disease, I wasn’t all that surprised that it was a food causing my problems.  I would have never put my finger on it, but I’d already spent three years in Africa thinking about how food and water were the absolute foundation for global health.  They are the common thread connecting all of us.  I’d had this sneaking suspicion for quite some time that this common thread could also probably be the source of much of the illness.  I was about to begin learning how they could also be the source of healing.

 If the most nourishing foods could restore my health, they had to be produced in the most nourishing environments.  The dirt itself had to be healthy.  The conditions for the cows, chickens, pigs, and fish had to be clean and happy, if I wanted the nutrients in the meat to serve my body well.  The vegetables and fruits couldn’t be covered in poisonous pesticides or pumped full of genetic modifications, if I expected the powerful vitamins and minerals in them to aid my recovery.  It went beyond that though.  The people growing and harvesting my food deserved safety and security on the job and a decent living too.  If I knew them personally and could see they too enjoyed happy, healthy lives, I knew I could trust them to take special pride in their work and produce foods safe for me to eat.  As I learned, my values started to change.

 I am by no means 100% there yet, but more and more what I eat reflects my values.  My plate shows the world what really matters to me.  Healthy, well cared for animals, organic veggies and fruits raised in wholesome soil, farmers I know, trust, and am happy to help support . . . these are the things I have come to value as I’ve spent the last year healing and growing outside my former comfort zones.

 I think we are in the middle of a rapidly growing food movement.  We (especially those of us who have had health recoveries and can speak to the power of it) have an extraordinary opportunity to change how we, as a whole society, eat.  This is our moment to speak up, raise awareness, and share how food can change our health and our communities.  Changing how we eat, changes everything else . . . how we treat ourselves, our neighbors, our livestock, our water, our soil . . . our planet.  I’m no longer apathetic about a subject that is so integral to everything.  My hope is to raise my daughter to be part of a generation that won’t need to get sick before they get passionate about dirt.

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Teaser Excerpt from The Paleo Approach: Probiotic Supplements

February 18, 2013 in Gut Health, Supplements, The Paleo Approach Excerpts

The Paleo Approach by Sarah BallantyneLast week I posted a teaser excerpt from The Paleo Approach about the importance of including probiotics (while the book is written from the perspective of autoimmune disease, the benefits of probiotics extend to all health conditions and human health in general).  However, there are many people who don’t do well with fermented foods (reasons might include a yeast sensitivity, which is common in people with gluten intolerance, or a histamine sensitivity) or who just plain old don’t like them.  So, it’s no surprise that that post prompted a series of questions about probiotic supplements.  I have decided to share another excerpt from the book with you to help answer the question of probiotic supplements.

I should probably mention that both of the specific brands of probiotics mentioned in this section are ones that I take myself (and chose after a great deal of research).  I’ve been taking these for 4 or 5 months and really like both of them.  I also heard Chris Kresser rave about Prescript-Assist in his most recent podcast (just in case you were looking for a second opinion!).

This excerpt is from Chapter 8 (the supplements chapter).

As mentioned in Chapter 6,different strains of probiotics confer different effects on your body.  However, from the vast array of different probiotic bacteria (approximately 35,000 species), only a handful have been characterized.

As previously mentioned, probiotic supplementation was shown to be beneficial for the management of every autoimmune disease in which it has been tested, including: inflammatory bowel disease, autoimmune myasthenia gravis, celiac disease, rheumatoid arthritis, multiple sclerosis, and autoimmune thyroid disease.  However, it is important to note that there is also some conflicting information.  In fact, there is convincing evidence that both bifidobacterium and lactobacillus probiotic bacteria (the two most common bacterial genera in probiotic supplements) are a source of autoantibody formation through molecular mimicry in autoimmune thyroid disease (discussed in Chapter 2).  Furthermore, there have been reports of severe eosinophilic syndrome—a condition characterized by elevated eosinophils (a type of white blood cell important for the innate immune system) in the blood with damage to cardiovascular system, nervous system, and/or bone marrow—directly attributable to the use of probiotics (both in people with a history of autoimmune disease but also in completely healthy individuals).

What does this mean?  If you do not tolerate fermented foods, probiotics are definitely worth trying.  The majority of the evidence in the scientific literature supports their potential benefits; however, some caution is advisable.  Just as in the case of fermented foods, probiotic supplements can be added after following The Paleo Approach for several weeks (at least 3) in the case of people with severe gastrointestinal symptoms or known bacterial overgrowth.

Which probiotics should you take? Probiotic supplements fall into two categories:

kirkman bio goldLactobacillus/Bifidus:  Lactobacillus and bifidobacterium are the two most heavily studied genera of probiotic bacteria.  They are also the most commonly found in supplement form.  It is important to note that even though the majority of scientific studies show health benefits of these strains, these are also the strains that may contribute to autoantibody formation and to severe eosinophilic syndrome in some people.

If you choose to take a lactobacillus and bifidobacterium supplement, look for a brand with as many different strains as possible (for greater probiotic diversity).  However, be cautious:  dairy ingredients are common in these types of supplements.  Look for a bottle that specifically brands itself as dairy-free, gluten-free, soy-free, corn-free, wheat-free, egg-free, peanut-free, and tree nut-free.  Also look for one that is yeast-free if the reason you are taking a probiotic supplement instead of eating fermented foods is yeast sensitivity concerns.  One high-quality brand to look for is Kirkman.

Start with a low dose, even breaking open a capsule and sprinkling a small amount in your food or in a small cup of water.  Alternatively, you can take your probiotic supplement every 2 or 3 days.  Over the course of several weeks, work your way up to the suggested dose on the bottle, taken daily.  Some probiotic supplements recommend taking with food while other recommend taking them on an empty stomach.  It is typically best to follow the specific recommendation of the brand you are using.  If your probiotic supplement does not have directions regarding whether or not to take it with food, first try taking it on an empty stomach.  After several weeks, switch to taking with food and see if you notice any improvement.

prescript-assist-probiotic-largeSoil-Based Organisms:  While not as extensively studied as probiotics from the lactobacillus and bifidobacterium genera, soil-based organisms hold extreme promise for modulating the immune system and correcting gut dysbiosis.  They have been shown to have extreme therapeutic potential in Irritable Bowel Syndrome and provide probiotic organisms that are routinely missing from our modern, over-hygienic lifestyles yet are normal residents of a healthy gut.

One brand to look for is Prescript-Assist which contains 29 different strains of soil-based organisms and is also dairy-free, gluten-free, soy-free, corn-free, wheat-free, egg-free, peanut-free, tree nut-free and yeast-free (also none of the strains included in Prescript-Assist come from the lactobacillus or bifidobacterium genera, or indeed any of the strains typically found in fermented foods).  Prescript-Assist has one of the best diversity of any probiotic supplements available.  Soil-based organisms seem to be better tolerated than lactobacillus and bifidobacterium, although extensive comparisons have not been made.

It is typically recommended to take two capsules daily (divided into two doses) for thirty days, followed by one capsule once or twice per week as a maintenance dose.  Because the strains in soil-based organism probiotics are different from the probiotic strains typically found in fermented foods, it is worth strongly considering taking a soil-based probiotic even if you are eating fermented food or taking a lactobacillus and bifidobacterium-based probiotic supplement.

Bittner AC, Croffut RM & Stranahan MC, Prescript-Assist probiotic-prebiotic treatment for irritable bowel syndrome: a methodologically oriented, 2-week, randomized, placebo-controlled, double-blind clinical study, Clin Ther. 2005 Jun;27(6):755-61.

Bittner AC, et al., Prescript-assist probiotic-prebiotic treatment for irritable bowel syndrome: an open-label, partially controlled, 1-year extension of a previously published controlled clinical trial, Clin Ther. 2007 Jun;29(6):1153-60

Jirillo E, Jirillo F & Magrone T, Healthy effects exerted by prebiotics, probiotics, and symbiotics with special reference to their impact on the immune system, Int J Vitam Nutr Res. 2012 Jun;82(3):200-8

Kiseleva EP, et al., The role of components of Bifidobacterium and Lactobacillus in pathogenesis and serologic diagnosis of autoimmune thyroid diseases, Benef Microbes. 2011 Jun;2(2):139-54.

Klaenhammer TR, et al., The impact of probiotics and prebiotics on the immune system, Nat Rev Immunol. 2012 Oct;12(10):728-34

Kverka M & Tlaskalova-Hogenova H, Two faces of microbiota in inflammatory and autoimmune diseases: triggers and drugs, APMIS. 2012 Oct 24.

Mendoza FA, et al., Severe eosinophilic syndrome associated with the use of probiotic supplements: a new entity?, Case Report Rheumatol. 2012;2012:934324

Veerappan GR, Betteridge J &Young PE., Probiotics for the treatment of inflammatory bowel disease, Curr Gastroenterol Rep. 2012 Aug;14(4):324-33.

Vyas U & Ranganathan N., Probiotics, prebiotics, and synbiotics: gut and beyond, Gastroenterol Res Pract. 2012;2012:872716.

 

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The Benefits of Probiotics –Teaser Excerpt from The Paleo Approach

February 12, 2013 in Gut Health, Supplements, The Paleo Approach Excerpts

The Paleo Approach by Sarah BallantyneThere are many topics that I am researching and writing about for the book that I’ve been meaning to write about for the blog for ages (the book just gives me a firm deadline).  I have decided take some of these topics (especially the more blog-sized ones) and publish them as teaser excerpts for the book (also because I think this information should be here too).

The book also contains a detailed (yet easy-to-follow) description of the components of the immune system, so when you read the book, you’ll already know why modulating Th1 versus Th2 versus regulatory T-cells is important and you’ll know what dendritic cells, antigen presentation and cytokines are. For a quick primer: Th1 and Th2 cells are over-activated in autoimmunity and cause damage (typically one or the other is over-activated).  Regulatory T-cells are supposed to keep all the other immune cells in check and suppress both over-activation of the immune system and autoimmunity (they tend to be deficient in autoimmune disease).  Cytokines are chemical messengers of inflammation.  Dendritic cells are a type of sentinel cell that detects foreign invaders.  Antigens are small sequences of amino acids on foreign invaders that are recognized by the immune system.   When a dendritic cell detects foreign invaders, they “show” the antigens to B-cells and T-cells (cells of the adaptive immune system).  Gut-Associated Lymphoid Tissue is the collection of immune cells and other tissues just inside the intestinal barrier in the gut.  Enterocytes are the cells that line the small intestine and form the barrier between inside the gut and outside the gut.

So, forgive the references to Chapters 2, 3, 8 and 12.  While you’ll have to wait until the book is out in September to read those sections, in the meantime, please enjoy this part of my section of probiotics (actually, probiotics are talked about in 4 separate sections-this section is from the chapter on healing foods).

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Consumption of probiotics, either as a supplement or in the form of unpasteurized fermented foods, can dramatically help modulate the immune system.  A vast number of scientific and clinical studies have evaluated the various effects of the commensal bacteria in the gut (those healthy gut bacteria) and/or probiotic supplement of specific bacterial strains on various aspects of the immune system.  The cliff notes?  It’s all good.

The exact mechanisms behind the many observed benefits of probiotics remain largely unknown.  This may be because different bacterial strains have different effects on the body and interact differently with the immune system.  For example, some probiotic strains stimulate production of cytokines (those chemical messengers of inflammation) that promote Th1 cell development (which may augment the immune system to help fight infection and prevent cancer).  Other probiotic strains stimulate production of cytokines that promote regulatory T-cell development, thereby providing that all important immune system modulation needed in autoimmune disease (see Chapter 2).  Yet other probiotic strains, including several lactobacillus strains, are beneficial both in diseases of compromised immune systems and diseases of excessively activated immune systems.

It has been shown that probiotics interact with dendritic cells during antigen presentation during the initiation of adaptive immune responses, meaning that probiotics are useful in preventing immune-related diseases (see Chapter 2).  However, they also affect the effector phase of adaptive immunity, so they can be used as a treatment for established immune-related diseases (this applies to both immune-related diseases like asthma and allergies but also autoimmune diseases).  In fact, probiotic supplementation has been shown to be beneficial in a variety of autoimmune conditions, including:  autoimmune myasthenia gravis, inflammatory bowel diseases, rheumatoid arthritis, multiple sclerosis, and autoimmune thyroid disease.

It used to be believed that probiotic supplementation and the consumption of unpasteurized fermented foods provided health benefits by re-inoculating the gut with beneficial strains of bacteria and yeast.  Having a healthier variety and types of gut microorganisms would then be responsible for the positive benefits of probiotic supplementation.  However, recent scientific research puts this explanation into doubt—at least in some cases.  A recent study of diarrhea-predominant Irritable Bowel Syndrome demonstrated that the administration of probiotic supplements did not to alter the composition of the gut microflora.  It’s important to emphasize that probiotic supplementation was still beneficial.  This implies that the benefits of probiotic consumption might be directly due to the interaction of those probiotic bacteria (and yeast) with the gut-associated lymphoid tissue (see Chapter 2) as it passes through the body, at least in some cases.

There are clearly still some situations where probiotic supplements do have profound effects on the gut microflora.  For example, studies have shown differences in the composition of the gut microflora after taking antibiotics in people who supplemented with probiotics compared to those who didn’t.  There may also be more impactful effects on those with bacterial overgrowths.  Probiotic microorganisms have the capability to affect the gut microflora through a variety of mechanisms, including: reducing the acidity in the intestinal lumen (the area in the middle of the “tube” that forms the gut), competition for nutrients, secretion of antimicrobial compounds by the probiotics themselves, stimulating the production of antimicrobial compounds by your cells, and preventing adhesion and interaction of other bacteria with gut epithelial cells.  In these ways, probiotics may help to “correct” gut dysbiosis.

Beyond restoring balance to the gut microflora and modulating the immune system, research has shown that administration of probiotics can have a direct effect on the tight junctions between enterocytes in the gut—resulting in decreased intestinal permeability.  So, taking a probiotic or eating food naturally rich in probiotic organisms can directly help heal a leaky gut.

As already mentioned in Chapter 3, what you eat has a profound effect on the types, relative quantities and location of different bacteria growing in your gut—this effect is largely independent of the benefits of consuming fermented foods or taking probiotic supplements.  However, consuming probiotics has the great potential to speed healing and modulate the immune system and should not be underrated in importance when dealing with autoimmune disease.

Some researchers are taking on the task of characterizing the precise effects of each probiotic strain on the human body (recall that there are approximately 35,000 of them among all humans).  Certainly some strains have already been isolated for their anti-inflammatory and immune modulatory properties, yet others for their abilities to improve the barrier function of the gut or the ability to reduce visceral hypersensitivity.  It is completely possible that in the future, probiotic supplements will be tailored to address specific health problems by providing specific strains known to counteract those issues.  However, until then, the best focus is on variety.

Because different probiotic strains have slightly (and sometimes vastly) different effects (which may also depend on your genetics, level of inflammation, and current gut health), the best way to ensure complete modulation/regulation of the immune system is to consume as many different probiotic strains as possible.  So, where do you get variety?  You actually get far more variety from fermented foods and soil than you do from most supplement available (that doesn’t mean that probiotic supplements aren’t useful—see chapter 8 for more information specific to probiotic supplements).  Every time you make a new batch of homemade sauerkraut, the probiotic organisms within it will be slightly different.

So, what are good food sources of probiotics?

  • Raw unpasteurized sauerkraut
  • Raw unpasteurized lactofermented vegetables (kimchee, beets, carrots, pickles)
  • Raw unpasteurized lactofermented fruits (green papaya, chutneys)
  • Raw unpasteurized lactofermented condiments (relishes, salsas)
  • Water kefir
  • Milk kefir grown in coconut milk
  • Kombucha
  • Beet Kvass

Some form of probiotic should be consumed every day.  It is typically understood that a small amount several times per day is more beneficial than a large amount at one sitting.  When you first start consuming probiotic foods, it’s a good idea to keep the amount very small (as little as 1 teaspoon) and see how you feel.  Some people with severe gut dysbiosis can have dramatic gastrointestinal symptoms from probiotics.  If one probiotic food doesn’t work for you, try another.  If none of them work for you, you may have more luck with a supplement or just might need more time to heal your gut before introducing probiotics.  It’s okay if you need to follow The Paleo Approach for a couple of weeks before adding probiotic foods (for more information, see the Troubleshooting section in Chapter 9).  The amount you eat at any given time can then be slowly increased over the course of several weeks.  And of course, you can skip ahead to Chapter 12 to start making probiotic foods in your own home.

An often underrated source of probiotics is soil.  Soil-based organisms (SBOs) have not been as extensively studied as the lactobacillus and bifidus genus of bacteria.  However, they are normal residents of a healthy gut, have been shown to be potent modulators of the immune system, and supplementation with SBOs has been shown to be beneficial in diabetes, chronic fatigue syndrome, insomnia and Irritable Bowel Syndrome.  Soil-based probiotic supplements are available (see Chapter 8 for more information).  You can also get exposure by playing in the dirt (a good excuse to take up gardening as a hobby!) and by growing your own vegetables organically (or buying locally-grown organic vegetables) and eating them without washing them.  Okay, you can rinse the big clumps of dirt off.

 

Barbara, G., et al., Mucosal permeability and immune activation as potential therapeutic targets of probiotics in irritable bowel syndrome, J Clin Gastroenterol. 2012 Oct;46 Suppl:S52-5

Bittner, A.C., et al., Prescript-assist probiotic-prebiotic treatment for irritable bowel syndrome: an open-label, partially controlled, 1-year extension of a previously published controlled clinical trial, Clin Ther. 2007 Jun;29(6):1153-60.

Chae, C.S., et al., Prophylactic effect of probiotics on the development of experimental autoimmune myasthenia gravis, PLoS One. 2012;7(12):e52119.

Corridoni D, et al., Probiotic bacteria regulate intestinal epithelial permeability in experimental ileitis by a TNF-dependent mechanism, PLoS One. 2012;7(7):e42067

Fooks LJ and Gibson GR Probiotics as modulators of the gut flora. Br J Nutr 2002 88(Suppl 1):S39–S49.

Gerritsen, J. et al., Intestinal microbiota in human health and disease: the impact of probiotics, Genes Nutr. 2011 August; 6(3): 209–240.

Kiseleva, E.P., et al., The role of components of Bifidobacterium and Lactobacillus in pathogenesis and serologic diagnosis of autoimmune thyroid disease, Benef Microbes. 2011 Jun;2(2):139-54.

Kobayashi T, et al.,  Probiotic upregulation of peripheral IL-17 responses does not exacerbate neurological symptoms in experimental autoimmune encephalomyelitis mouse models, Immunopharmacol Immunotoxicol. 2012 Jun;34(3):423-33

Le Bert, N., et al., DC priming by M. vaccae inhibits Th2 responses in contrast to specific TLR2 priming and is associated with selective activation of the CREB pathway, PLoS One. 2011 Apr 1;6(4):e18346

Michail, S. & Kenche, H., Gut microbiota is not modified by Randomized, Double-blind, Placebo-controlled Trial of VSL#3 in Diarrhea-predominant Irritable Bowel Syndrome, Probiotics Antimicrob Proteins. 2011 Mar;3(1):1-7

Ng SC, et al., Mechanisms of action of probiotics: recent advances. Inflamm Bowel Dis. 2009;15(2):300–310.

Ruemmele F.M., et al., Clinical evidence for immunomodulatory effects of probiotic bacteria, J Pediatr Gastroenterol Nutr. 2009 Feb;48(2):126-41.

Shida, K. & Nanno, M., Probiotics and immunology: separating the wheat from the chaff, Trends Immunol. 2008 Nov;29(11):565-73.

Shida K, et al., Flexible cytokine production by macrophages and T cells in response to probiotic bacteria: a possible mechanism by which probiotics exert multifunctional immune regulatory activities, Gut Microbes. 2011 Mar-Apr;2(2):109-14

Schiffer, C., et al., A strain of Lactobacillus casei inhibits the effector phase of immune inflammation, J Immunol. 2011 Sep 1;187(5):2646-55

Tlaskalová-Hogenová, H., et al., Commensal bacteria (normal microflora), mucosal immunity and chronic inflammatory and autoimmune diseases, Immunol Lett. 2004 May 15;93(2-3):97-108.

Tsilingiri K & Rescigno M., Postbiotics: what else?, Benef Microbes. 2012 Dec 27:69-75.

Soil-based organisms improve immune function: shift cytokine profile from TH2 to TH1, Posit Health News. 1998 Spring;(No 16):16-8

http://www.old-herborn-university.de/literature/books/OHUni_book_8_article_4.pdf

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The WHYs behind the Autoimmune Protocol: Alcohol

November 8, 2012 in Foods in Moderation, The WHYs of the AIP

Alcohol is restricted in the paleo diet autoimmune protocol; and for those of us with autoimmune disease, it can feel like there are no pleasures left!  My inner monologue goes something like this “Seriously, first I give up grains, legumes, dairy, modern vegetable oils and refined sugar.  THEN, I give up eggs, nightshades, nuts, seeds, coffee and chocolate.  And NOW you want me to give up my wine?!  I thought red wine was supposed to be good for me! Waaaaaaah”

Moderate consumption of alcohol (not just red wine) seems to provide diverse health benefits; including reducing the risk of cardiovascular disease 1, reducing the risk of developing type II diabetes 2, preventing Alzheimer’s disease 3, and it may even reduce the risk of some cancers 4. (Don’t get too excited about the cancer prevention piece… moderate alcohol consumption also increases the risk of other cancers.)  While alcohol is not technically paleo, there is certainly evidence that prehistoric man would have imbibed fermented fruit and probably got pretty darned stinkin’ drunk from time to time.  Almost every version of the paleo diet condones low to moderate consumption of alcohol (usually restricted to gluten-free alcohols, so mainly wine and spirits), including Prof. Loren Cordain and Robb Wolf.   It is a Neolithic pleasure that most people following a paleo diet still enjoy.

So, with all the research supporting that moderate consumption of alcohol (especially wine) is healthy, why is it then a problem for those with autoimmune disease?  Once again, it boils down to the fact that those with autoimmune disease have more sensitive systems and face more challenges to healing a leaky gut than others.

Alcohol consumption directly causes an increase in intestinal permeability (i.e., a leaky gut) 5.  Alcohol unravels the tight junctions and adherens junctions that glue the cells that line the gut (called gut epithelial cells or enterocytes) together to form the  barrier between the inside of the gut where undigested food and bacteria live and the inside of our body.  Effectively, alcohol creates little holes between the gut epithelial cells.  It does this through several mechanisms 5.  Importantly, the “holes” that alcohol makes in the gut epithelial barrier are known to be big enough to allow some very large molecules into the body, most notably endotoxin.  Endotoxin is a toxic protein derived from the cell walls of gram-negative bacteria, such as E. Coli, which live in our guts (usually in the large intestine, but often in the small intestine in those people with autoimmune disease).  As these bacteria die (as part of their normal life cycle), endotoxin is released.  If it gets into the blood stream, it stimulates systemic inflammation, stimulates the immune system, and damages the liver 5.

Normally the majority of bacteria that grow in our guts are gram-positive bacteria (although some gram-negative bacteria is normal).  What does gram-negative and gram-positive mean?  This refers to a staining technique that differentiates between these two major classes of bacteria.  Basically, gram-negative bacteria have more complex cell membranes/walls and these tend to be pathogenic (i.e., they cause disease).  E. coli is an example of a gram-negative bacteria.  Lactobacillus (the probiotic found in supplements, yogurt and fermented vegetables) is an example of a gram-positive bacteria.  So, here’s the kicker:  alcohol consumption feeds gram-negative bacteria such as E. Coli to create bacterial overgrowths of these more toxic bacteria and therefore excess endotoxin production in the gut.  Excessive alcohol consumption is also correlated with gram-negative bacteria growing very high up the digestive tract, in the duodenum and sometimes even the stomach 5,6.

So, alcohol increases the production of endotoxin within the gut and increases intestinal permeability to endotoxin.  Another toxin that is produced by both gram-negative and gram-positive bacteria is called peptidoglycan (another component of the cell wall that is released into the gut when the bacteria die).  There is evidence that alcohol increases the permeability to peptidoglycan and that this toxin is very effective at stimulating the immune system and causing inflammation 5.

And that’s not all.  Even fairly small amounts of alcohol can damage the lining of the gut; specifically, alcohol leads to “mucosal damage in the upper small intestine with a loss of epithelium at the tips of the intestinal villi, hemorrhagic erosions and even hemorrhage in the lamina propria” 5.  If that sounded bad, that’s because it is.  It’s similar to the damage caused by gluten in celiac patients.

Most of the current understanding of the link between alcohol consumption and increased intestinal permeability (a.k.a. leaky gut) comes from studies of chronic alcohol consumption.  But, there are studies to show that this damage occurs even from a single drink.  Occasional drinkers basically don’t damage their intestines as much because they don’t consume as much alcohol at one time and they have more time for the guts to heal in between drinks.  This might lead to some adaptive mechanisms, which might be part of how low-to-moderate alcohol consumption can actually provide a health benefit.

So, what does this mean for those with autoimmune disease?  If you have autoimmune disease, you have a collection of genes that makes you more susceptible to developing a leaky gut and to having an exaggerated immune reaction to substances that leak out.  This means that anything that increases intestinal permeability should be avoided.

There’s some good news.  If you are being very strict with the autoimmune protocol, you are likely to tolerate an occasional drink (make sure to stay away from any grain-based alcohols though, especially beer and ale which contain gluten).  Chris Kresser puts the limit on one 5oz glass of wine twice per week (or equivalent amount of hard alcohol that is not derived from grains such as rum, tequila, sherry, cognac and brandy).  However, I advise avoiding all alcohol until you are starting to see some success on the autoimmune protocol. 

There’s some other good news.  It’s actually the alcohol that is the problem here, which means that cooking with wine or hard liquor (where the alcohol is burned off in the cooking process) is totally okay.  Well, with one more caveat:  some people are can be sensitive to the yeast content of wine (the yeast used in wine fermentation is a potential gluten cross-reactor) or can be sensitive to the the sulfites found in wine.

In summary, alcohol is not good for anyone dealing with leaky gut issues.  However, an occasional drink once your body is healing is probably okay.  Cooking with alcohol is also probably okay for most people, even if you don’t tolerate an actual drink.  But once again, I do urge caution as you experiment to find where your individual line is.

1 http://www.sciencedaily.com/releases/2011/02/110222192913.htm

2 Mekary RA et al “Joint association of glycemic load and alcohol intake with type 2 diabetes incidence in women” Am J Clin Nutr December 2011 ajcn.023754

3 http://www.jsonline.com/features/health/50590097.html

4 http://www.theatlantic.com/health/archive/2012/01/the-truth-about-breast-cancer-and-drinking-red-wine-or-any-alcohol/251171/

5 Purohit V et al “Alcohol, Intestinal Bacterial Growth, Intestinal Permeability to Endotoxin, and Medical Consequences” Alcohol. 2008 August; 42(5): 349–361.

6 Sekirov I et al “Gut Microbiota in Health and Disease” Physiol Rev, 2010 July; 90( 3): 859-904

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