What is autoimmunity?

Autoimmunity occurs when your immune system repeatedly reacts against a particular tissue in your body, causing chronic inflammation and tissue damage.

This immune reaction against a self-tissue and the resulting chronic inflammation is at the root of all immune conditions, which include psoriasis, Hashimoto’s, Crohn’s, colitis, multiple sclerosis, type one diabetes and Coeliacs, as well as many more.

But why does the immune system react against one of my own tissues?

It is unclear what triggers this initial reaction against a self-tissue, but we know that when the body is in an inflammatory state, immune malfunction becomes more likely. So if something is causing temporary inflammation, such as a virus or other pathogen, the risk of the body reacting against one of its own tissues increases for people genetically predisposed to autoimmnity.

If this reaction against a self-tissue persists, organ damage and eventually system malfunction occurs. This is the pathologic condition known as autoimmune disease.

Once the body is in this state of chronic inflammation, the risk of inappropriate immune reactions to additional substances, such as certain foods, chemicals, or other bodily tissues, becomes more likely. This is because chronic inflammation can make it harder for the body to retain its ability to promote appropriate immune tolerance. This explains why people with autoimmune conditions often find they become increasingly intolerant to certain foods and other substances in their environment, as well as why the risk for additional autoimmune conditions increases.

As a registered nutritionist, when I start working with a new client, I build up a timeline of their key health events and we usually see that their autoimmune condition developed following a prolonged inflammatory event, such as a virus, a stressful period in their life, or exposure to an environmental pathogen, such as mold.

But why doesn’t autoimmunity affect everyone?

**Autoimmunity: genes, environment and gut barrier function**

***Genetics alone do not create a destiny of autoimmune disease.***

As the digram above shows, genetic make-up is known to play a role. The unfortunate combination of certain genes with certain environmental factors, during an inflammatory period, lays the foundations for autoimmunity to develop.

What is key here though is that genetics alone do not create an automatic destiny of autoimmunity. This is where nutrition and lifestyle play such an important role. Let’s look at the Environment circle in more detail.

How can natural diet and lifestyle changes help with autoimmunity?

Let’s look at what we mean by ‘Environment’.

Research suggests that environmental triggers for autoimmunity will normally fit into one or more of these four areas. In fact, these four areas don’t just serve as triggers for autoimmunity, they can also serve to mediate or exacerbate an autoimmune condition once it has developed. This is because the chronic inflammation driven by the autoimmune condition promotes immune intolerance, making the immune system more likely to react to substances it was previously tolerant of. A vicious cycle develops where intolerance drives further inflammation, which drives additional intolerances.

Let’s have a look at these four categories of environmental triggers:

1) Food

Food can trigger and exacerbate autoimmunity in a number of ways.

The western diet (high in ultra-processed foods and altered fats, allergenic proteins, sugar and salt, while low in fibre, polyphenols and fermented foods) has been found in multiple studies to contribute to inflammation, which promotes immune intolerance and heightens the risk of autoimmunity in genetically-susceptible individuals.

A recent landmark study from the renowned Francis Crick Institute (click here to read more about this study) found that countries which have recently begun to assume Western diets have seen a huge spike in autoimmune conditions in populations where autoimmunity was previously unheard of.

Specific food allergens, particularly certain proteins such as gluten and casein, can trigger and exacerbate inflammation and autoimmunity. Other foods such as nightshades, lectins, additives, as well as certain kinds of food processing, can also drive inflammation for some individuals, both increasing the risk of autoimmunity developing, and exacerbating existing autoimmune conditions.

Food allergies and intolerances are much more likely to develop when our guts are not working properly, as will be explained in the ‘Gut Barrier Function’ section below.

2) Infections

Infections due to viruses, bacteria, parasites, mould or yeast are a common trigger for autoimmunity in genetically-susceptibility individuals. In fact, it is often the ‘burden of infections’, rather than a solitary infection, which lays the groundwork for an autoimmune condition.

Antigens to the infection disturb the microbiota, which causes the release of endotoxins, leading to a loss of gut barrier integrity. When gut barrier integrity is compromised, the immune system struggles to maintain tolerance, leading to an increased risk of reactions to self-tissues (see Gut Barrier Function section below).

3) Stress & Trauma

Stress is a confusing term. When we talk about stress in the context of autoimmunity, we are really trying to identify whether your body is being stressed beyond its capacity to adapt and respond positively to its stressors. Research shows that high perceived stress scores directly correlate with high symptom scores in autoimmunity.

What is stress in the context of autoimmunity?

Let’s look at some of these areas in more detail so we can understand how they directly impact autoimmunity.

Early life trauma or Adverse Childhood Events (ACEs) are strongly associated with a hugely increased risk for autoimmunity in later life. ACEs can be any event in a child’s life that they find deeply traumatic. This could be a devastating life event, such as losing a parent or being abused, or something more insidious, such as not fitting in, or having affection or approval withheld from them.

Nutrient deficiencies can be a dramatic stressor on the body over time, as the body’s resources and ability to deal with its demands will be depleted. Nutrient deficiencies can occur because of insufficient nutrient intake, or indirectly due to factors such as poor gut health impacting absorption, or a longterm unresolved infection depleting the body of certain nutrients.

Difficulty in personal or work relationships can affect hormonal balance, particularly the adrenals. This may progress to disrupting blood sugar regulation (insulin), and consequently sleep. Reproductive hormones may also become unbalanced as a result. Any sort of hormonal dysregulation, be it. neurotransmitters (mood), adrenals (energy and metabolism) or reproductive hormones, can contribute massively to inflammation in the body, and consequently to immune intolerance and autoimmunity. Research also shows that chronically increased levels of cortisol, the ‘fight or flight’ hormone, interfere with the development of new immune cells in the thymus and increases the risk of immune malfunction and autoimmunity.

Insufficient quality and quantity of sleep is specifically linked to the onset and worsening of autoimmune disease. Research clearly demonstrates that it promotes immune intolerance, as well as decreasing the body’s ability to fight off infection and support healing and repair.

4) Toxins

Research has found that toxic exposure may be central to the development of autoimmunity. We are exposed to toxins on a daily basis, whether that is skin, hair and nail products, plastics and xenobiotics in our food, mouldy buildings or pharmaceuticals.

As with infections, it can often be about the overall toxic load and whether the body has the resources to cope. Toxins can contribute to inflammation and autoimmunity by impacting barrier function, creating an unmanageable toxic load for our bodies, or interfering with hormone regulation. Certain autoimmune diseases and/or symptoms are associated with specific toxins. Testing can give more insight into toxic exposure.

So we have looked at the environmental factors that can drive autoimmunity. But what about this third part of the picture: gut barrier function?

What is gut barrier function and what does ‘leaky’ gut’ mean?

Gut barrier function is vital to proper immune function. Around 70% of our immune system is located in our gut, since this is a huge interface between the us and the outside world. Our gut barriers are semi-permeable and determine which of the molecules from our gut passs through the gut wall into our bloodstream. When the delicate structure of our gut wall is damaged, this can lead to inappropriate substances entering our bloodstream. This can cause chronic immune reactions, inflammation and potentially autoimmunity. This is sometimes known as ‘leaky gut’. Damage to the gut wall barrier function has become an area of increasing interest in autoimmunity in recent years.

This diagram shows how damage to the microbial protective layer and the junctions between the cells can result in toxic and other inappropriate substances passing into the bloodstream, causing inflammation, food intolerances, nutrient malabsorption, and potentially autoimmunity.

So what causes this damage to the microbial lining and to the cell junctions?

Our gut microbes are disturbed by many factors prevalent in our Western diet and lifestyle, such as processed foods, particularly sugar, toxic chemical, chronic stress and a huge lack in diversity of dietary plant fibres. Yeast and parasites also disrupt beneficial microbes.

This disturbance to the balance of our gut microbes can lead to increased levels of endotoxins, which are harmful substances produced by unbeneficial bacterial in our gut. These toxins can pass through our gut wall when barrier function is disturbed reaching our bloodstream and contributing to autoimmune diseases and chronic inflammation.

When our gut barrier is not functioning well, incompletely digestive food molecules can inappropriately pass through into our bloodstream. As they are incompletely digested, they are not recognised by the immune system and can provoke an immune reaction, which can drive intolerances to those foods and further damage to the gut barrier.

One of the reasons why gluten is often avoided by people with autoimmunity, is that it can damage the junctions between the cells lining our gut wall. Gaps between the cells open up and allow unwanted substances to pass through into our bloodstream, again provoking unwanted immune responses and inflammation.

Gut barrier function has become a recent target for many autoimmune studies, the theory being that autoimmunity is not necessarily self-perpetuating, rather its process can be modulated or even reversed by optimising gut barrier function.

So what are natural diet and lifestyle changes that can help autoimmunity?

When we look at autoimmunity from a diet and lifestyle perspective, we are looking to identify and remove or reduce the environmental triggers from the four areas discussed above. We are also trying to improve gut barrier function by supporting healthy gut microbiota and removing any substances that may be damaging the structure of the gut, such as sugar, or foods that we are currently intolerant to. We look to ensure any nutrient deficiencies are addressed, by adding certain foods, optimising the digestion process to improve absorption, or using supplements. Lastly we check how well the digestive process is working as this controls how well foods are broken down to the correct state before passing into the bloodstream.

We often use testing to identify where environmental triggers are causing a problem, as well as to investigate digestive and gut barrier function, including the health of the gut microbes. We can also use testing to identify nutrient deficiencies.

The interventions we use are highly personalised and specific to the individual. It is harder to improve your autoimmune health if you do not have access to professional support and testing. However, there are still many things that you can do which can move the needle on your health. Here are some areas to consider, as well as links to further information on some of these areas:

Identify and remove any foods you think you are reacting to (signs of reactions can be bloating, belching, diarrhoea, constipation, irritability, rash, acne, dark circles under eyes, nausea, swelling), ideally re-introducing them one-by-one once your symptoms have settled. Common triggers are gluten, dairy, fish, eggs, corn/maize, nightshades, legumes such as lentils, sulphites, nuts and seeds. If you find high fibre foods cause bloating, this is more likely to be a gut microbiome issue - see point 7.
Regulate your blood sugar levels to decrease inflammation - this can be one of the most impactful self-led interventions. Click here to read my article on balancing your blood sugar levels.
Find ways to support yourself when dealing with the stressors in your life. This may be counselling, walking, sharing problems with friends, eating regular nourishing meals, making time for yourself, developing self-compassion or ensuring a positive sleep routine.
Improve your digestive capacity by reducing processed foods, relaxing before you eat, chewing thoroughly, increasing fibre and eating only at regular mealtimes, never late at night.
Adopt an anti-inflammatory diet - avoid processed foods and sugar, limit red meat and alcohol, increase healthy fats, and eat a wide range of plant and fermented foods. You can read more about an anti-flammatory diet for autoimmunity here.
Reduce or remove the toxins you are regularly exposed to, such as chemicals in skin care, household cleaning products or plastic containers for foods.
Nourish your microbiome and optimise your gut barrier function. Gradually increasing the range and volume of fibre and fermented foods that you eat will provide a better diet for the beneficial bacteria in your gut. These bacteria have an enormous influence on your immune system’s ability to promote tolerance and decrease inflammation, as well as supporting many other areas such as mood, blood sugar levels and digestion.
Take vitamin D over the winter months if you live in the UK or at a similar latitude. The NHS advises 10 micrograms per day for everyone over one year of age between October and March. Vitamin D is essential for promoting immune tolerance and the majority of the UK population is thought to be deficient.

Please remember, this is general advice and does not replace the individual advice of medical professionals. Always check with your doctor whether these steps are appropriate for you.

What is autoimmunity and how can natural diet and lifestyle changes help?