Food sensitivities, leaky gut & the microbiome tackling ...€¦ · The microbiome, inflammation, leaky gut, allergy and autoimmunity Degraded microbiome Small Intestine GI System

Food sensitivities, leaky gut & the microbiome – tackling the

autoimmune & allergy epidemic

Dr. John Mauremootoowww.newparadigmhealth.co.uk

All Disease Begins in The Gut.

~ Hippocrates (c. 460 – c. 370 BC): Greek physician, often referred to as the "Father of Medicine.”

• The rising tide of allergies and autoimmune disease• The role of leaky gut in allergies and autoimmune disease• The role of the microbiome in allergies and autoimmune

disease• How the microbiome has been damaged by modern life• How to manage the microbiome

Scope of presentation

The rising tide of allergies and autoimmune disease

The rise of allergies

Source: Abrahamsson et al. (2015)

1

2

3

1970 19901960 1980 2000

Year of birth

Rel

ativ

e in

crea

se Asthma

Eczema

The rise of autoimmune disease

Source: Atkinson et al. (2014)

Incidence of type 1 diabetes in children aged 0–14 years

Common diseases with autoimmune components

Source: O’Bryan (2016)

1. Alopecia (hair loss)2. Alzheimer’s disease3. Motor neurone disease4. Diabetes (type 1)5. Inflammatory bowel diseases (Crohn’s and colitis)6. Multiple sclerosis7. Nephropathies (kidney diseases)8. Neuropathies (brain and nervous system diseases) 9. Lupus10. Osteoarthritis11. Parkinson’s disease12. Psoriasis13. Rheumatoid arthritis14. Thyroid disease

Source: O’Bryan (2016)

Comprehensive List

1. Acute disseminated encephalomyelitis (ADEM) 2. Acute necrotizing encephalopathy 3. Addison’s disease 4. Agammaglobulinemia 5. Alopecia areata 6. Amyloidosis 7. Ankylosing spondylitis 8. Anti-GBM/ anti-TBM nephritis 9. Antiphospholipid syndrome (APS) 10. Autoimmune angioedema 11. Autoimmune aplastic anemia12. Autoimmune dysautonomia 13. Autoimmune hepatitis 14. Autoimmune hyperlipidemia15. Autoimmune immunodeficiency 16. Autoimmune inner ear disease (AIED) 17. Autoimmune myocarditis 18. Autoimmune oophoritis 19. Autoimmune pancreatitis 20. Autoimmune retinopathy 21. Autoimmune thrombocytopenic purpura (ATP) 22. Autoimmune thyroid disease 23. Autoimmune urticaria 24. Axonal and neuronal neuropathies 25. Balo disease 26. Behçet’s disease

27. Bullous pemphigoid 28. Cardiomyopathy 29. Castleman disease 30. Celiac disease 31. Chagas disease 32. Chronic fatigue syndrome 33. Chronic inflammatory demyelinating polyneuropathy

(CIDP) 34. Chronic recurrent multifocal osteomyelitis (CRMO) 35. Churg-Strauss syndrome 36. Cicatricial pemphigoid/ benign mucous pemphigoid 37. Cogan’s syndrome 38. Cold agglutinin disease 39. Congenital heart block 40. Coxsackie myocarditis 41. CREST syndrome 42. Crohn’s disease 43. Demyelinating neuropathies 44. Dermatitis herpetiformis 45. Dermatomyositis 46. Devic’s disease (neuromyelitis optica) 47. Discoid lupus erythematosus 48. Dressler’s syndrome 49. Endometriosis 50. Eosinophilic esophagitis 51. Eosinophilic fasciitis 52. Erythema nodosum

Source: O’Bryan (2016)

Comprehensive List (continued)

53. Essential mixed cryoglobulinemia 54. Evans syndrome 55. Experimental allergic encephalomyelitis 56. Fibromyalgia 57. Fibrosing alveolitis 58. Giant cell arteritis (temporal arteritis) 59. Giant cell myocarditis 60. Glomerulonephritis 61. Goodpasture syndrome 62. Granulomatosis with polyangiitis (GPA) 63. Graves’ disease 64. Guillain-Barré syndrome 65. Hashimoto’s encephalitis 66. Hashimoto’s thyroiditis 67. Hemolytic anemia68. Henoch-Schönlein purpura 69. Herpes gestationis70. Hypogammaglobulinemia 71. Idiopathic pulmonary fibrosis 72. Idiopathic thrombocytopenic purpura (ITP) 73. IgA nephropathy 74. IgG4-related sclerosing disease 75. Immunoregulatory lipoproteins 76. Inclusion body myositis 77. Interstitial cystitis 78. Juvenile arthritis

79. Juvenile diabetes (type 1 diabetes) 80. Juvenile myositis 81. Kawasaki disease 82. Lambert-Eaton syndrome 83. Leukocytoclastic vasculitis 84. Lichen planus 85. Lichen sclerosus86. Ligneous conjunctivitis 87. Linear IgA disease (LAD) 88. Lupus (SLE) 89. Lyme disease, chronic 90. Ménière’s disease 91. Microscopic polyangiitis 92. Mixed connective tissue disease (MCTD) 93. Mooren’s ulcer 94. Mucha-Habermann disease 95. Multiple sclerosis 96. Myasthenia gravis 97. Myositis 98. Narcolepsy99. Neuromyelitis optica (Devic’s syndrome) 100. Neutropenia 101. Ocular cicatricial pemphigoid 102. Optic neuritis 103. Palindromic rheumatism 104. PANDAS (pediatric autoimmune neuropsychiatric disorders

associated with streptococcal infections)

Source: O’Bryan (2016)

Comprehensive List (continued)

105. Paraneoplastic cerebellar degeneration 106. Paroxysmal nocturnal hemoglobinuria (PNH) 107. Parry-Romberg syndrome 108. Parsonage-Turner syndrome 109. Pars planitis (peripheral uveitis) 110. Pemphigus 111. Peripheral neuropathy 112. Perivenous encephalomyelitis 113. Pernicious anemia114. POEMS syndrome 115. Polyarteritis nodosa 116. Polyglandular syndromes (type I, II, and III autoimmune) 117. Polymyalgia rheumatica 118. Polymyositis 119. Postmyocardial infarction syndrome 120. Postpericardiotomy syndrome 121. Primary biliary cirrhosis 122. Primary sclerosing cholangitis 123. Progesterone dermatitis 124. Psoriasis 125. Psoriatic arthritis 126. Pure red cell aplasia 127. Pyoderma gangrenosum 128. Raynaud’s phenomenon 129. Reactive arthritis 130. Reflex sympathetic dystrophy 131. Reiter’s syndrome 132. Relapsing polychondritis133. Restless legs syndrome

134. Retroperitoneal fibrosis 135. Rheumatic fever 136. Rheumatoid arthritis 137. Sarcoidosis 138. Schmidt syndrome 139. Scleritis 140. Scleroderma 141. Sjögren’s syndrome 142. Sperm and testicular autoimmunity 143. Stiff person syndrome144. Subacute bacterial endocarditis (SBE) 145. Susac’s syndrome 146. Sympathetic ophthalmia 147. Takayasu’s arteritis 148. Temporal arteritis/ giant cell arteritis 149. Thrombotic thrombocytopenic purpura (TTP) 150. Tolosa-Hunt syndrome 151. Transverse myelitis 152. Type 1 diabetes 153. Ulcerative colitis 154. Undifferentiated connective tissue disease (UCTD) 155. Uveitis 156. Vasculitis 157. Vesiculobullous dermatosis 158. Vitiligo 159. Wegener’s granulomatosis/ granulomatosis with

polyangiitis (GPA)

The role of leaky gut in allergies and autoimmune

disease

What is leaky gut and why is it important?

Source: BallenaBlanca - CC BY-SA 4.0

Undigested food particles,Microorganisms and toxins

Healthy tight junction

Unhealthy tight junction

Inflammation, leaky gut, allergy and autoimmunity

Small Intestine

Bacteria Food particles Fungus

Blood Bacterial toxins Food particles Fungal toxins

Target organs Allergic & autoimmune responses

Leaky Gut Inflammation

Immune system reactions

The role of the microbiome in allergies and autoimmune

disease

How many genes do humans have?

20,488Source: (Pennisi, 2007

How does this compare with other organisms?

30,907

107,891

20,947

24,502

95,216

With so few genes, how are we

apparently so sophisticated?

Digestion

Temperature control

Protection

DigestionMetabolism

Weight managementVitamin synthesisImmune systemNervous system

Source: Kristen Earle, Gabriel Billings, KC Huang & Justin Sonnenburg/Nikon Small World 2015

The Microbiome

Source: Kristen Earle, Gabriel Billings, KC Huang & Justin Sonnenburg/Nikon Small World 2015

The most densely populated ecosystem known

Interest in the microbiome has exploded

Interest in the microbiome has exploded

Interest in the microbiome has exploded

Source: (Turnbaugh et al., 2006

Most of our DNA is microbial

www.synbiocyc.org

And most of these microbes are beneficial

Most of our genes are microbial

allergiesandyourgut.com

Your body has over

40 times as many

microbial genes as

human genes

The microbiome pulls our strings

Appetite

Hormones

SCFA

Food Intake

Fibre Intake

Appetite

Appetite regulation

Hormones

Appetite regulation in a traditional diet

SCFA

Food Intake

Fibre Intake

Source: Sleeth et al. (2010)

Appetite

SCFA

Hormones

Fibre Intake

Appetite regulation

Appetite regulation in a western diet

Food Intake

Source: Sleeth et al. (2010)

The microbiome, inflammation, leaky gut, allergy and autoimmunity

Degraded microbiome

Small Intestine

GI System

Leaky Gut

Bacteria Food particles Fungus

Blood Bacterial toxins Food particles Fungal toxins

Target organs Allergic & autoimmune responses

Bacterial overgrowth

Barrier degradation

Dysmotility Inflammation

Immune system reactions

How the microbiome has been damaged by modern life

• Antibiotic use from (before) the cradle to the grave• Caesarean delivery• Bottle feeding• WMD• Modern sanitary practices• Infections• Drugs e.g. NSAIDs, PPIs• Pollution including agrochemicals• Sleep deprivation• Psychosocial factors.

Antibiotics: a four-edged sword

4. Microbiome damage

1. Individual health benefit

3. Antibiotic resistance

2. Community health benefit

The toxic/stress bucket

www.helloliteracy.com

Air pollution

Agrochemicals

Injuryinfection

Traumatic events

Poor nutritionExercise

Poor sleep

Electromagnetic radiation

Drugs

Source: Blaser (2016)

Microbiome Decline

Source: De Filippo at al. (2010)

Microbiome Decline

Microbiome Decline

Source: Sonnenburg et al. (2016)

Bacterial species in the gut microbiota

Comparisons of different stages of microbiota extinction

Microbiome Decline

Source: Sonnenburg et al. (2016)

Diet influences microbiota decline

How to manage the microbiomePersonal actions: What can be done now?• Natural childbirth and breast feeding• Minimise the use of antibiotics• Don’t over-sanitise• Eat high fibre foods… but go gradual• The Three P’s: Prebiotics, Probiotics, and Phytochemicals• Eat fermented foods• Avoid allergens• Minimise processed food• Avoid artificial sweeteners• Drink pure water• Filter washing water• Minimise Roundup intake• Connect with nature / get a dog.

How to manage the microbiome

Medium to long term public health measures• Health warnings on antibiotics• Abolish factory farming• Improve prenatal and post-natal support• Develop narrow-spectrum antibiotics• Improve diagnostic tests to differentiate between bacterial

and viral infections, among specific bacteria, and also distinguish between colonisation and infection

• Develop personalised approaches to antibacterial therapies as standard.

Can we restore the microbiome?

Source: Blaser (2016)

Can we restore the microbiome?

Source: Sonnenburg et al. (2016)

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Can we restore the microbiome?

Source: Sonnenburg et al. (2016)

Initial

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Can we restore the microbiome?

Source: Sonnenburg et al. (2016)

Initial

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Can we restore the microbiome?

• Yes – examples from lifestyle changes and faecal transplants

Summary

• The microbiome modulates the effects of the environment on all aspects of health including allergies and autoimmunity.

• Microbiome degradation is at the centre of the growing epidemic of chronic disease

• Microbiome restoration is substantially under our control.

The Medical Perspective

All Disease Begins in The Gut.

~ Hippocrates (c. 460 – c. 370 BC): Greek physician, often referred to as the "Father of Medicine.”

Health is modulated by the microbiome.

~ Hippocrates (c. 460 – c. 370 BC): Greek physician, often referred to as the "Father of Medicine.”