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Gut Bacteria and Auto-Immune Diseases

New studies show that two auto-immune diseases, chronic fatigue syndrome and rheumatoid arthritis, may be caused by having pro-inflammatory bacteria in your gut. These bacteria are likely to punch holes in your intestines, which allows bacteria to slip into your bloodstream to cause inflammation.
• You have billions of bacteria in your colon, more than ten times as many bacteria as you have cells in your body. Some of the colon bacteria are good for you and help you absorb food and fight infections, while some bad bacteria can punch holes in your intestines to cause what is called a "leaky gut." This allows bacteria to pass through your intestines into your bloodstream.
• Your immunity responds by producing large amounts of cells that eat and destroy bacteria, and proteins that attach to bacteria, dissolve their outer membranes and kill them.
• Usually your immunity kills the invading germs and then quiets down. However, the bad bacteria in your colon can keep punching holes in your intestinal linings, and allow more bacteria to keep entering your bloodstream, so your immunity stays active all the time. This is called inflammation.
• If your immune cells and proteins stay active all the time, they can use the destructive forces that are supposed to attack invading germs to attack your own healthy cells. For example, they can attack your joints to cause rheumatoid arthritis, they can damage your brain and nerves to make you tired all the time and cause chronic fatigue syndrome, and they can damage your own DNA to increase your risk for certain cancers.

The New Research on Chronic Fatigue Syndrome
Cornell researchers used DNA sequencing to show that patients with chronic fatigue syndrome have intestines that have a much more limited variety of different types of bacteria than normal people do, and have far more pro-inflammatory intestinal bacteria (the types that turn on your immunity and punch holes in your intestines to cause inflammation). Chronic fatigue sufferers also have far more abnormal blood tests that show that their immunities are overactive. (Microbiome, June 23, 2016). The authors propose that these bacteria lead to a "leaky gut" that allows bacteria to pass from the intestines into the blood stream. It is likely that Crohn’s disease and ulcerative colitis, characterized by intestinal and colon ulcers, have the same cause. The researchers write that they can diagnose Chronic Fatigue Syndrome correctly in more than 83 percent of patients through analyzing the different bacteria in stool samples and using blood tests to measure inflammation. Extensive data show that infection with intestinal bacteria or viruses may cause chronic fatigue syndrome (J Clin Med, June 6, 2016;5(6)). If future studies confirm their findings, chronic fatigue syndrome will be treated with:
• following an anti-inflammatory diet loaded with plant fiber,
• avoiding pro-inflammatory foods,
• taking certain antibiotics, and
• receiving special "good" bacteria or stool transfers from healthy people.

The New Research on Rheumatoid Arthritis
Researchers at the Mayo Clinic used genomic sequencing to show that people with rheumatoid arthritis have large amounts of specific pro-inflammatory colon bacteria that are extremely uncommon in healthy people (Genome Medicine, June 2016; 8(1)). They also showed that having large amounts of the gut bacteria Collinsella is associated with rheumatoid arthritis in mice. They then treated rheumatoid arthritis-susceptible mice by placing in their intestines an anti-inflammatory bacterium called Prevotella histicola and showed that it markedly reduced the joint damage and swelling and other symptoms of rheumatoid arthritis (Arthritis and Rheumatology, June 23, 2016). Furthermore, the anti-inflammatory bacteria reduced the villous atrophy and other damage to the intestinal linings of the mice with rheumatoid arthritis and the blood markers of inflammation that are characteristic of rheumatoid arthritis. Since the bacterium Prevotella lives in a healthy human gut, it is likely to be a very safe treatment.

Diagnosing Chronic Fatigue Syndrome or Myalgic Encephalomyeletis (ME)
Chronic fatigue syndrome has been given another name, myalgic encephalomyeletis (ME). The predominant symptom is extreme fatigue even after sleep; other symptoms may include muscle and joint pain, migraines and gastrointestinal distress. People with this condition can take weeks to recover from minor exertion. In the past, doctors had no blood tests or X rays to diagnose chronic fatigue syndrome, so it was often believed to be a psychological problem. Now doctors can use stool analysis, intestinal biopsies and blood tests for levels of inflammation to diagnose the condition. The Cornell researchers showed that the following measures of inflammation are abnormally high in chronic fatigue or ME sufferers:
• C-reactive protein (CRP)
• intestinal fatty acid-binding protein (I-FABP)
• lipopolysaccharide (LPS)
• LPS-binding protein (LBP)
• soluble CD14 (sCD14).

Previous studies have shown that people who suffer from chronic fatigue syndrome have:
• overactive immune systems (J Affect Disord, Sept 5, 2013;150(2):223-30)
• elevated immuno-inflammatory pathways, mitochondrial dysfunctions with depleted levels of adenosine triphosphate (ATP), increased levels of pro-inflammatory cytokines (interleukin-1, tumor necrosis factor-α, nuclear factor-κB), a predominance of effector B cells and autoreactive T cells -- all markers of auto-immune disease (Mol Neurobiol, Spr 2014;49(2):741-56)
• autoantibodies (Brain Behav Immun, May 2014;38:249-62)
• "leaky gut," holes in their intestinal linings following an exercise challenge (PLoS One, 2015 Dec 18;10(12):e0145453)

Rheumatoid Arthritis Treatments
More than 1.5 million North Americans suffer from the joint damage of rheumatoid arthritis, a disease that can also damage skin, eyes, heart, lung and blood vessels. Several studies showed that rheumatoid arthritis may be triggered by infection and that antibiotics might help to prevent and treat this joint destruction. I treated many of my rheumatoid arthritis patients with antibiotics and had some notable successes. However, antibiotics have failed to cure most cases of rheumatoid arthritis and most rheumatologists do not use this treatment. Instead, they use immune suppressants, drugs to slow down a person's immunity. This month's studies are exciting because they now offer a potential cure for many of the so-called auto-immune diseases, in which a person's immunity is overactive and doctors can't find a germ that is causing it. This new research suggests that when antibiotics have helped rheumatoid arthritis patients, they may have done so by changing the colony of gut bacteria from predominantly pro-inflammatory species to predominantly anti-inflammatory ones.

Current Treatment of Auto-Immune Diseases
Autoimmune diseases include: alopecia areata, autoimmune hemolytic anemia, autoimmune hepatitis, Crohn's disease, dermatomyositis, diabetes (type 1), some forms of juvenile idiopathic arthritis, glomerulonephritis, Graves' disease, Guillain-Barre syndrome, idiopathic thrombocytopenic purpura, myasthenia gravis, some forms of myocarditis, multiple sclerosis, pemphigus/pemphigoid, pernicious anemia, polyarteritis nodosa, polymyositis, primary biliary cirrhosis, psoriasis, rheumatoid arthritis, scleroderma/systemic sclerosis, Sjogren’s syndrome, systemic lupus erythematosus, some forms of thyroiditis, ulcerative colitis, some forms of uveitis, vitiligo, granulomatosis with polyangiitis (Wegener’s) and myalgic encephalomyeletis (ME), formerly known as chronic fatigue syndrome, and possibly fibromyalgia.

If you are diagnosed with an auto-immune disease, realize that intensive research is going on to see if changing your gut bacteria can treat you. Even though some reports are very encouraging, doctors still have not proved that they can cure any auto-immune disease by changing your gut bacteria. At this time, most doctors prescribe some form of immune suppression for auto-immune diseases.

My Recommendations
I believe that most people diagnosed with an auto-immune disease should be managed with an anti-inflammatory lifestyle in addition to their other treatments. Even if it is not effective in treating or curing your auto-immune disease, an anti-inflammatory lifestyle is associated with less disease and longer life. However, you must check with your doctor first to be sure that you will not be harmed by any lifestyle change. My anti-inflammatory lifestyle guidelines are:
• Eat lots of fruits and vegetables
• Restrict red meat, sugared drinks, sugar-added foods and fried foods
• Exercise
• Avoid being overweight
More on an anti-inflammatory lifestyle: Inflammation can Help or Harm

Checked  8/5/17

July 24th, 2016
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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