The Disobedient Gut
Restoring Health Naturally
My patients and friends often ask me the same question: Why does a rheumatologist, who treats autoimmune ailments, chronic inflammatory diseases, and arthritis, spend so much time dealing with diet, gastrointestinal issues, and dietary supplements? My answer is that without fixing the gut you cannot restore immune balance (homeostasis) and effectively treat chronic illnesses.
The traditional postulate states that autoimmune diseases develop when there is a miscommunication between our body and its environment. And what is the biggest influence on our body? Food—we are what we eat.
Most of us think the main connection between our body and the environment is our skin, but it is actually our digestive tract. If you unfold the small intestine and its microscopic, finger-like villous structures, you will uncover a surface area of nearly 2000 square feet (about the size of a singles tennis court) which is approximately 100 times larger than the surface area of our skin!
Our gastrointestinal system is the main entry for foreign materials (foods) into the body and the main transitory route for an enormous mass of microorganisms and the byproducts of their activity (feces). Food ingredients and microbial products are the main stimulants of the immune system and the main external regulator of various metabolic pathways. Accordingly, the composition of the food we consume can influence immune responses and inflammatory processes leading to the development of distinct forms of arthritis and autoimmune disease. In other words, your body reacts to the food you eat.
Irritable bowel syndrome (IBS) is one of the most common functional (meaning without specific anatomic damage of the gut) disorders associated with autoimmune and chronic inflammatory diseases. Typical symptoms of IBS include abdominal pain or discomfort, bloating, diarrhea or constipation, as well as a feeling of incomplete bowel evacuation (tenesmus).
In rheumatology, the most common conditions associated with IBS include fibromyalgia, chronic fatigue syndrome, chronic inflammation disorders such as ankylosin and spondylitis, psoriasis and psoriatic arthritis, Sjogren’s syndrome, lupus, and scleroderma.
The connection between autoimmune diseases and IBS is bidirectional (moving or operating in two usually opposite directions).
Certain illnesses can trigger IBS symptoms. For example:
- Scleroderma and chronic infections (such as Lyme disease) damage the fine network of nerve cells responsible for the synchronized movement of various segments of the digestive tract (peristaltic movement).
- Lupus or vasculitis can interfere with the blood supply to the gut.
- Sjogren’s syndrome can damage the pancreas and interfere with food digestion, eventually causing bacterial overgrowth in the gut.
- Ankylosing spondylitis, psoriasis, and psoriatic arthritis can trigger IBS symptoms via inflammatory pathways.
On the other hand, IBS can exacerbate symptoms of fibromyalgia and chronic fatigue and cause various psychosomatic symptoms frequently complicating autoimmune diseases. What follows is an actual case from our clinic where an integrative approach was used to diagnose and treat a woman with lupus and IBS.
A 62 year old woman, Susan*, with a history of lupus came to the clinic to get a second opinion regarding the nature and management of her symptoms. Since early adulthood she dealt with bouts of fatigue, generalized stiffness, joint pain, eye and mouth dryness, and increased sensitivity to sunlight. Her symptoms were manageable until she entered menopause in her early fifties and started experiencing extreme fatigue, amplified joint pain, canker sores, hair loss, and various skin rashes. She was seen by several physicians, including two rheumatologists, and was eventually diagnosed with lupus. She tried several traditional prescription drugs for lupus, however, she failed to tolerate them either because of severe gastrointestinal discomfort or because of the drug-induced skin rashes. When she came to me, she had very few doubts about her diagnosis, but wanted to find a different way to control her symptoms.
Upon her initial physical examination, Susan had obvious stigma of lupus. Furthermore, her blood test results showed not only evidence of lupus (lupus-specific autoantibodies) but also evidence of ongoing lupus activity (low levels of specific complement components). As a rule of our clinic, all patients with an autoimmune disease undergo a basic genetic analysis focused on specific disease-related genes. The genetic profile of Susan showed the presence of celiac-associated genes. During the follow-up appointment, I discussed with Susan her laboratory test results and mentioned the discovery of celiac-associated genes. Almost instantly her face turned red and she said, “Dr. Shikhman, I did not want to mention during my initial visit that for over thirty years I have been dealing with almost daily bouts of diarrhea, bloating, and awfully smelling stool. I try to avoid any social activities and things which I used to enjoy because my disobedient gut acts up in a very unpredictable way.” Apparently, since the age of fifty, Susan had several colonoscopies and upper endoscopies but none of them revealed abnormal findings, including celiac disease.
After discussing the role of genetic factors and potential gluten intolerance contributing not only to her abdominal symptoms but also to her main diagnosis (lupus activity), I offered her a “nothing-to-lose” treatment plan consisting of a gluten-free diet for a three month trial period. In addition, I recommended she take a high potency anti-inflammatory probiotic, Bacillus coagulans.
After following the gluten-free diet for three months, I evaluated her again. Her face radiated positive emotions and she sounded very optimistic. Susan stated that after one month on a gluten-free diet she noticed a remarkable increase in energy, decreased joint pain, and near complete resolution of skin rashes. Accidental consumption of gluten reproduced her previous symptoms within 24 hours. Thankfully, they were short lasting.
She mentioned that her abdominal discomfort had also subsided by 70-80%, however, her frequent bowel movements had not significantly reduced in frequency. She became a strong believer that most of her problems were driven by food and wanted to proceed with a broader food intolerance testing based on our in-house IgG4 food intolerance panel. The test revealed potential problems with cow-based dairy products, eggs, corn, and pineapple. She was instructed on how to do the food-specific elimination diet and tried it for another three months.
During her next follow-up, she reported that all her symptoms, except for diarrhea, had resolved almost completely. Due to the persistency of the diarrhea, we performed a comprehensive stool analysis that demonstrated the presence of an intestinal parasite, Blastocystis hominis. She underwent several cycles of a recommended anti-parasitic antibiotic therapy which resulted only in a transient reduction of diarrhea. Subsequently, she tried a combination of Ayurvedic antimicrobial herbs and her diarrhea stopped completely. Her stool analysis showed complete eradication of the parasite. To her great satisfaction, after one year of the integrative therapy (food intolerance testing, diet modifications, and supplements) the blood test results showed complete disappearance of lupus-specific antibodies and normalization of complement levels indicating lupus remission. Susan’s health was restored.
Susan’s recovery from IBS and her associated illness demonstrates how integrative medicine offers alternative healing paths even when all seems hopeless. The right diet and supplements are a powerful therapeutic tool capable of making a difference in people’s lives.
*This is a fictitious name used to protect patient identity. Please consult your doctor before implementing any new protocol.
By Dr. Alex Shikham