One of the causes of autoimmune diseases, including RA is leaky gut syndrome. Diet in rheumatic diseases should therefore eliminate products that may adversely affect the tightness of the intestinal barrier: gluten, milk and eggs. Another therapeutic diet used in RA is the low-antigen diet. See the principles of the gut-sealing diet for a sample menu and a list of anti-inflammatory medications in rheumatic diseases.
What are the causes of rheumatic diseases?
Inflammatory rheumatic diseases - including rheumatoid arthritis (RA), reactive arthritis, psoriatic arthritis, ankylosing spondylitis, lupus, juvenile idiopathic arthritis - included in autoimmune diseases (with autoimmune disease) . They are based on the excessive activity of the immune system, which begins to attack its own tissues, resulting in inflammation. What irritates the immune system to such an extent that it causes disease? Can this unfavorable situation be influenced? The human body contacts the outside world, including through the skin and small intestine. If the intestinal villi were to be broken out in such a way, they would form the surface of the tennis court (200 m²)! And, among others that's why there is as much as 70-80 percent underneath. immune system cells. It is the longest limit that he must defend against the attack of hostile substances. It is made up of a single layer of intestinal epithelial cells (enterocytes) glued together with various proteins, which are designed to let certain substances pass through and inhibit others. In a he althy person, this barrier is tight, and what passes from the intestine into the body is strictly controlled.
It happens, however, that the proteins that connect the cells of the intestinal epithelium open up, and sometimes the enterocytes themselves are destroyed. Then microscopic "holes" are formed, through which undesirable substances enter the body - not fully digested fragments of proteins, whether from food or microorganisms. This pathological condition is calledleaky gut syndrome . It is much more common in autoimmune diseases than in he althy people. Why is it dangerous? Proteins are made of several dozen amino acids. Any protein -maize, mouse, human - it is different, but certain amino acid sequences can be repeated in them. The tight intestinal barrier usually does not allow peptide fragments (amino acids linked together) to pass through, only individual amino acids. But if it doesn't work, strings of amino acids pass through it, and the immune system starts reacting with inflammation or producing antibodies that "cling to" these incompletely digested protein fragments. If the peptides that penetrate resemble some proteins in our body (e.g. part of the proteins in the joints), the antibodies attack not only what enters the body from the outside, but also our own tissues.
Sealing the gut barrier may be crucial in the treatment of autoimmune diseases
Mechanism of intestinal leakage
In 2001, Dr. Alessio Fasano, a gastroenterologist at Massachusetts General Hospital in Boston, discovered the mechanism of leakage. It is influenced by two factors that open proteins between enterocytes: lipopolysaccharides of bacteria (fragments of their cell membranes) and gluten (proteins found in wheat, rye, barley). The researcher noticed that the removal of the factor causing the weakening of the intestinal barrier results in the calming down of the autoimmune disease, such as celiac disease, and remission. Today we know that autoimmune diseases depend on three factors:
- genetic predisposition,
- some environmental factor (e.g. a hormonal breakthrough, such as pregnancy or menopause, bacterial and viral infections, a long series of antibiotic therapy),
- intestinal leakage.
We have no influence on the first two elements, but we have control over the last one. Dr. Fasano sayssealing the gut barrier may be crucial in the treatment of autoimmune diseases,including inflammatory rheumatic diseases.
Intestinal sealing diet in the treatment of rheumatic diseases
For this reasondiet in rheumatic diseaseseliminates products that may adversely affect the tightness of the intestinal barrier. It should definitely be a gluten-free diet. But sometimes this is not enough because there are a group of foods that contain proteins similar to gluten and the body can react to them in a so-called cross-reactions, which is the same as to gluten. It has been shown that 50 percent. patients with celiac disease (this group has the most studies when it comes to gluten) such reactions occur in relation to dairy. In this case, not eating gluten and eating dairy products increases intestinal leakageand maintains the inflammatory reaction, so some patients who eliminate only gluten from their diet do not significantly improve their he alth.
According to the original approach of Małgorzata Desmond, who deals with intensive nutritional therapy in rheumatic diseases, patients are given a choice of three diets.
1.Diet without gluten, milk and eggs
The easiest diet is a gluten-free, dairy-free and egg-free diet, but it can be insufficient because there may be other proteins that will cross-react (or otherwise) stimulate the immune system and thus keep the gut leaky. This is likely to be the case if no signs of improvement appear after three to four months of following a gluten-free diet, milk, and egg diet. Then a low-antigen diet is necessary.
2.Low-antigen diet
Low-antigen diet eliminates products that may adversely affect the tightness of the intestinal barrier in various ways: dairy products, whole grains, eggs, legumes, and in some cases also nuts and seeds. What can you eat? Meat, fish, poultry, fruit, vegetables, coconut, avocado, olive oil, olives, sweet potatoes, or yam tubers (yam) or plantain bananas (cooked). This diet option seems to have the best chance of improving your he alth, but you must strictly follow the recommendations. The diet is used for 6-12 months depending on the disease. In the case of disease markers (e.g. antibodies) or inflammatory markers, it is checked after 3 months whether the titer of these antibodies is decreasing or inflammation is decreasing. Sometimes the therapeutic effect is only verified by the patient's subjective feelings.
3.Individual diet program
The third type of gut-sealing diet is based on an in-depth diagnosis of gluten cross-reactions. It can be used from the beginning or as a recovery from a low-antigen diet. First, a test is performed to see if the body reacts to other foods as it does to gluten. Not only IgG antibodies are tested, but also - which is not common - IgA. This test helps to structure the diet according to the individual reactions of the immune system, but it is always assumed that 100 percent. it is not exact. Therefore, you should be on a low-antigen diet for the first 8 weeks, and then introduce other products based on the test results with caution and monitor your symptoms.
This will be useful to youIntestinal sealing diet - a sample daily menu
BREAKFAST fruit smoothie: blend ripe bananas, 1/2 cup each of strawberries and blueberries (frozen),a handful of young kale, half an avocado, a glass of coconut milk enriched with calcium
LUNCH salad with boiled broccoli, garlic, sweet potatoes, dill, olive oil and salmon
DINNER chicken in spinach with ginger, stewed mushrooms with onion and asparagus in olive oil, steamed sweet potatoes, romaine lettuce leaves
Prepared by: Małgorzata Desmond
Getting out of a gut-sealing diet
Quitting a low-antigen diet after 6 or 12 months (depending on the blood test results and the patient's well-being) consists in gradually introducing individual products (except gluten) every 3-4 weeks and observing the body's reaction. The test can be repeated after 2 months. Dr. Aristo Vojdani, the eminent immunologist who invented all food intolerance tests in the 1980s and now refined them, says that if antibodies persist after 12 months of elimination diet and after re-introducing products in the test, these products should be permanently excluded. The meaning of an elimination diet is to reduce the inflammation that exacerbates the symptoms of the disease and destroys the joints. The anti-inflammatory effect of the diet consists not only in excluding products that adversely stimulate the immune system, but also in introducing anti-inflammatory products.
Worth knowingMedicinal products to alleviate inflammation in rheumatic diseases
Berries- anti-inflammatory, incl. thanks to the presence of catechins and quercetin, which block the activation of genes responsible for inflammatory processes.
Green leafy vegetables- contain many phytochemicals (including carotenoids, flavonoids) that have anti-inflammatory properties. Cruciferous vegetables - contain glucosinolates that reduce inflammation in the body. In addition, cruciferous vegetables contain isothiocyanates, including sulforaphane, an anti-inflammatory compound that blocks the production of an enzyme related to the destruction of articular cartilage.
Bulb vegetables- anti-inflammatory.
Vitamin D- seals proteins between enterocytes. The basis is the determination of the concentration of vitamin D in the blood, because with deficiencies of this vitamin, which often occur in people with autoimmune diseases to a greater extent than in the rest of the population, intestinal leakage is increased.
Turmeric extract- Preliminary clinical studies suggest that the turmeric component curcumin may reduce symptoms of rheumatoid arthritis (RA). In one of the studies, the preparation was even more effective than the non-steroidal onesanti-inflammatory drugs after 8 weeks of treatment.
Omega-3 acids(EPA and DHA) - taking high doses of these acids (under the supervision of a specialist) with the simultaneous use of certain non-steroidal anti-inflammatory drugs may reduce the duration of morning stiffness in patients with RA. Taking fish oil also helps to lower your doses of NSAIDs.
Note! Taking turmeric extract and omega-3 fatty acids is effective when you follow the recommendations of the entire diet.
monthly "Zdrowie"