Anti-Inflammatory Diet

All health care starts with diet. My recommendations for a healthy diet are here:
Anti-Inflammatory Diet and Lifestyle.
There are over 190 articles on diet, inflammation and disease on this blog
(find topics using search [upper left] or index [lower right]), and
more articles by Prof. Ayers on Suite101 .

Thursday, December 19, 2013

Antibiotics, Gluten, Hashimoto's Thyroiditis and Baldness

My impression is that Hashimoto's is caused by a combination of an initial immune attack on the thyroid and incompetent regulatory T cells.  In most cases the immune attack on the thyroid is a secondary consequence of celiac/gluten intolerance, in which anti-transglutaminase antibodies attack transglutaminase bound to gluten in the intestines.  Transglutaminase  is an enzyme that is also produced by the thyroid (and hair follicles) and attack by celiac antibodies can enhance or inhibit thyroid hormone production (or baldness.)  Both Hashimoto's and celiac do not occur if the suppressive part of the immune system, i.e. regulatory T cells, is functioning.  

Antibiotics Compromise the Immune System
The major point here is that antibiotics disrupt normal bacterial biofilms that line the intestines and these healthy gut bacteria are required for development of regulatory T cells.  Compromise of Tregs leads to autoimmune diseases, e.g. celiac, Hashimoto’s and baldness, and also allergies.

Antigens/Allergens Have Basic Amino Acid Triplets
The antigens targeted in autoimmune diseases, e.g. tTG, anti-nuclear, TPO, and allergies form an obvious pattern.  All of these antigens and allergens have simple amino acid sequences (rare patches of three basic/positively charged amino acids) that enhance their presentation to the immune system to produce antibodies.  Nuclear proteins, for example, are frequent autoantigens and most of these proteins interact with nucleic acids (negatively charged) and have predictable patches of positively charged amino acids (arginine and lysine).  Other common autoantigens have basic amino acid (arg/lys) patches, because they interact with phospholipids (also negatively charged.)  Proteins with basic patches, e.g. HIV-TAT or heparanase, are also readily transported into cells and nuclei.  Peptides with these sequences are produced by action of stomach enzymes on proteins, e.g. milk lactoferrin, and are antimicrobial.

Allergies / Autoimmune Diseases Are a Predictable Consequence of Antibiotics
Doctors treat with antibiotics, but they fail to repair damage that they cause to gut flora.  The gut flora of most patients treated with antibiotics, especially those who are most fastidiously hygienic, never fully recover.  Constipation is a common symptom of severe dysbiosis and related immunoincompetence.  Probiotics are gut flora bandaids and do not survive as components of gut flora.

Gut bacteria are also needed for development of the aggressive part of the immune system.  Thus, autoimmune diseases can be treated with even more intense use of antibiotics, that will eliminate the rest of the immune system.  Since all vitamins are produced by gut flora as quorum sensing signals, antibiotics can also produce the exotic symptoms of vitamin deficiencies.

Antibiotics are essential to many therapeutic approaches, e.g. surgical procedures or therapy for chronic Lyme disease, but they must be used responsibly and treated patients must be subsequently tested to ensure a repaired gut flora and a functional immune system have been reestablished after antibiotics.  Long term antibiotic use needs special attention, e.g. deliberate Repair of Gut Flora or a fecal transplant.

Thus, I think that it is most likely that ever increasing antibiotic exposure and processed foods, coupled with obsessive hygiene have led to crippled gut flora (as observed in the simplified gut microbiomes of Americans), a net decline in suppressive Tregs and the observed increase of autoimmunity and allergies.  The competence of the immune system may be a major determinant in the course of infection with a pathogen that can produce chronic infections.


Anonymous said...

Dr. Ayers, for years I've been navigating the mine fields of internet misinformation. I've finally arrived! I desperately try to grasp the terminology and concepts behind yours and other's findings. Most of which, unfortunately, is far beyond me. But I've also read in the forums on (i"m working on my ankylosing spondylitis) that along-side a low/no starch diet, antibiotics and fecal transplants can be of significant benefit. Can you recommend anybody for me to speak to regarding kinds of antibiotics, dosages and durations etc.?
Do you have an opinion regarding biologics?
If Dr.'s were celebrated in our societies the way that athletes and singers would be the Michael Jordan of inflammation;) Good luck and thank you for your write-ups.

Kay Dee said...

Dr. Ayers, there are most cases in Anti TPO is positive (Hashimoto) and Anti Transglutaminase is negative - in theses cases where is the trigger and how process evolves.
Thank You for sharing you Science


CC said...

Thank you for your interesting posts/research.

Dr. Ayers have you found anything besides fecal transplant to increase or build a healthier gut flora?

I ask because fecal transplant is currently only legal for C Difficile in the states.


jeremywallace said...

Dear Doctor Ayers. Thank you for this informative and interesting blog. I came across this blog when I was searching for answers to my father's illness. In summer he suffrered a number of haemmorragic strokes caused they presumed by an amyloid angiopathy (he responeded quite well to steroid therapy). The doctors treating him said this was a rare condition of unknown aetiology. I am doctor myself and for some years was working with alzheimer's patients and was well aware that amyloid was also implicated there and recent developments suggest alzheimer's is a result of rampant cerebral inflammation. Anyway in googling amyloid I came across your blog which I have worked through more or less from beginning to end. The long and short of it is that my Father was for many years put on long term Augmentin for the prophylaxitic treatment of recurrent chest infections as he had bronciectasis. He ate yogurt daily and swallowed down an omega 3capsule every morning with his breakfast but after my mother died 4 years ago I noticed his diet deteriorated e.g. sliced white bread and margarine were staples. He died a few weeks ago of Chronic moncytic myeloblastic leukaemia (which he'd had for a number of years) something I always suspected might be linked to the augmentin as well. The webssite Rxisk where patients self report side effects has 2 cases of myelodysplasia and 2 cases of amyloidosis listed as reported under augmentin. In your opinion do you think both of these diseases could be linked to taking augmentin on a long term basis? I'm not planning on sueing anyone but am interested to find out for curiosities sake.

I should add I have over last year adjusted my diet as I have suffered from psoriasis for some time. Following a diet similar to the one you outline I have more or less rid myself of psoiriasis and lost weight at the same time. I find that wheat is the biggest culprit when it comes to psoriasis.

best wishes,

Jeremy Wallace

Anonymous said...

I recently read that proton pump inhibitors(PPIs) and antacids(acid suppressing drugs)can lead to vitamin B12 Cyanocobalamin) deficiency and contribute to food allergies and food intolerance. After taking PPIs for years(12+), i have develop intolerance to gluten, casein, and egg protein. I also bruise easily.
Lam JR, Schneider JL, Zhao W, Corley DA. Proton Pump Inhibitor and Histamine 2 Receptor Antagonist Use and Vitamin B12 Deficiency. JAMA. 2013;310(22):2435-2442. doi:10.1001/jama.2013.280490.

Anonymous said...

Dr. Ayers,
I have recently discovered your blog and have scoured it for information on the infant gut, especially since your wife is a breastfeeding expert.
Here is my question: I am the mother of a newborn who was birthed naturally and vaginally (although I was given 1 dose of penicillin for possible group b about 40 minutes before he was born), at 4 weeks old he got a bad RSV infection and had to be hospitalized, he was put on iv rocephrin for 36 hours. He has been exclusively breastfed since birth (aside from some iv fluids and pepcid at the hospital). I know that you say that breastfed infants are colonized by bifidobacterium sp, and according to my research he would have been colonized by the first week of life.

I'm really interested in giving him the best gut health possible, and I don't know how much of an impact those antibiotics had on him. I've read studies that infants given antibiotics in the first 48 hours of life have less diversity in their microbiota (and there are of course the studies about increased obesity and allergies with early antibiotic use). But it seems like if his gut was properly colonized with bifidobacterium by four weeks and if I continue to exclusively breastfeed him for at least 6 months (I plan to breastfeed him for at least 2 years) his gut should be able to heal?

I'm also using an infant probiotic to be safe and he was given lactobacilli at the hospital.
Any thoughts on first foods I should introduce at 6 months? Any thoughts on how his gut health should influence his vaccination schedule? We have an organic veggie patch and I've been getting him close to the soil and even putting a little on his hands. :)

I would be so grateful for your input as my pediatrician was no help and just said that the iv antibiotics wouldn't have affected his gut health at all.
thank you so much for all of your information.

Anonymous said...

Dr. Ayers,

What are your thoughts on helminths?

I'd also like to know what you think about chronic use of low dose antibiotics? Do you think that can also damage the biofilm in the gut? I ask this because my son has Cystic Fibrosis and part of the protocol is 500 mg of azithromycin 3x a week. The pulmonologists say this dosage reduces inflammation and results in fewer lung exacerbations.

Anonymous said...

Hi Dr. Ayers, I have Hashimoto's thyroiditis and was diagnosed back in 2003 when I was just 12 years old. About a year ago I wanted my endocrinologist to test my blood for possible Celiac's disease and it turns out that I do not have it. You mentioned that the immune attack on the thyroid is a secondary response to celiac/ gluten intolerance, so I'm just confused since that does not seem to apply in my situation. Thanks and I appreciate your valuable insight/ feedback!

laustan said...

The trespasser is called an antigen. Antibodies tie to these antigens like a lock and a key. Each cell has antigens and these are what the resistant framework perceives. Also, every cell in our body has a self-antigen which should tell the invulnerable framework that our own particular tissue isn't an awful gentleman.

Once the terrible fellows have been named, different parts of the safe framework are flagged and they assault and, as a rule, execute the awful gentlemen. Now and again these antibodies can kill the awful fellows without anyone else and not need to sit tight for fortifications.

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