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Your Gut—No, Not That One, This One
hat we eat in general, our diet, and how we prepare food have changed significantly in the last 60 or so years. This is most notable in industrialized countries as well as in cities all over the world. Since time immemorial, we ate food when it was available and when it was in season. After a harvest of grains, vegetables, or fruits, we ate what was gathered. As an example, we did not eat strawberries in winter. Meat consumption was rare for most people and usually it was caught or trapped in the wild. All of this has very much changed and been transformed. We now consume new strains of wheat, rice, soy, and corn, which were not available before; we have genetically modified (GM) crops and, in the United States, we use and eat more GM crops than all the other countries in the world combined. We use chemicals on and in our foods, such as insecticides, pesticides, and fungicides on vegetables and fruits. Concentrated animal feeding operations (CAFOs), which include cattle, hogs, chicken, and turkey, use antibiotics, hormones, and heavy metals, such as arsenic, in feeding these animals. For example, CAFOs use ractopamine to increase the meat content in cattle: It is a β-agonist drug that is known to augment protein synthesis. It is also banned in 160 countries, including China, Europe, and Russia. There is widespread use of other chemicals, such as food coloring, artificial flavorings, and artificial preservatives in our foods. We use artificial sweeteners liberally and not only in soft drinks, adding to the pandemic of obesity. Salt adversely affects our cardiovascular and immune systems yet we consume, on average, more than twice the amount that we should. Salt is often added into foods we eat, especially canned goods, but also into bread and other staple foods. Bisphenol A, a plasticizer, is used in food containers, such as plastic bottles for soft drinks, other liquids, and cooking oil, and is used to line the inside of canned goods. It leaches into the contents of the container. Glass containers have mostly been replaced by plastic ones and are now much more common than ever before in all areas of our supermarkets and grocery stores. There are other chemicals we use or, we should say, overuse, such as antacids, antihistamines, histamine-2 blockers, and antibiotics. This last prescription drug has been shown to be highly overprescribed in the United States. The others are available to the general public over-
the-counter. All these xenobiotics were not part of what we consumed, nor were most available and used until after World War II. As for food preparation, microwaving food and using coated pots and pans for food preparation is new as well. For generations since the beginning of humankind, we were neither exposed to these nor did they form part of our diet. And there is much more that cannot fit into this editorial. Concurrently with all these changes in our diet, there has been a disturbing increase in autoimmune diseases, mostly in the developed countries since World War II, which suggests a possible cause and effect. This increase is both in the incidence and prevalence of autoimmune disorders, including multiple sclerosis, rheumatoid arthritis, Crohn’s disease, and type 1 diabetes mellitus.1,2 There are more than 80 autoimmune disorders where the immune system targets cells, organs, or tissues of its own body. More than 50 million Americans are affected, women much more so than men: It is one of the 10 leading causes of death in female children and women of all ages. In contrast, cancer affects 13 million Americans.3 Autoimmune disorders can be triggered by infections, environmental factors, genetic predisposition, and gut dysbiosis. They can take a long time to develop and initial symptoms are vague and nonspecific. It has been become more and more apparent recently via a number of studies that the gut plays a greater role in autoimmunity than previously thought. The surface of the gut is approximately 200 to 300 square meters, about the size of a tennis court, and this is where we come into greatest contact with the outside world. The single cell layer of interconnected epithelial cells that line the gut have secretory, digestive, and absorptive functions. These epithelial cells are reinforced by tight junctions in the paracellular spaces between them. The tight junctions act as highly regulated gates that open and close depending on the signals from bacterial components from the lumen and cytokines, and they are essential for intestinal diffusion mechanisms. The epithelial cells are covered by mucin; this forms the initial barrier between the contents of the gut, including commensal bacteria, and the epithelial cells.4 Neuropeptides can increase the permeability of tight junctions and change the function of the mucosal barrier. Secretory IgA is one of
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Gill SR. This is known as oral tolerance and begins at birth. 99th Dahlem conference on infection. smoking.16(5):341-346.9 The gut and the brain communicate bidirectionally via neural. Buist AS. The enteric nervous system. N Engl J Med . 2006.35(11):1466-1472. Science. Physiological. Int J Immunophatol Pharmacol.” controls the gastrointestinal system.7 This is more than 10 times the total amount of cells in our body.41(12):2493-2498. MD Editor in Chief REFERENCES 1. about 103. 2 immune system. 2010. et al. Sadowski D. McGregor JA. 5. Metagenomic analysis of the human distal gut microbiome. Qin J. MS has been linked in studies to elevated intestinal permeability and to infections with bacteria and viruses. pathological. The effect of infections on microbiome is seen more and more as playing a large role in our immune system and in autoimmunity. 2010. It is interesting to note that the number of genes in our intestinal microbiota is 150 greater than the number of genes in the human genome. 2002. and patients are usually seen by physicians once the symptoms are more prominent and debilitating. The importance of the microbiota affecting the patient years later has been demonstrated in studies showing the predisposition of infants delivered via Caesarean section to asthma. To subscribe. Microbes.11 Autoimmunity takes time to develop. 2005. 75% of patients suffering from new onset rheumatoid arthritis carried Prevotella copri in their microbiota. However. gastrointestinal transit time.com. carries 1012 bacteria. Am J Pathol. and autoimmune diseases later in childhood. this change can lead to responses by the immune system. Gilliland FD. The intestinal immune system balances the protective mechanisms against intestinal pathogens with the tolerance of commensal bacteria and food antigens. and therapeutic implications of zonulinmediated intestinal barrier modulation: living life on the edge of the wall. The intestinal epithelium is exposed on an ongoing basis to massive amounts of foreign materials that can be either beneficial or harmful. Salam MT.464(7285):59-65. inflammation and chronic inflammatory disorders: psycho-neuroimmunology and the intestinal microbiota: clinical observations and basic mechanisms. 11. Pop M. Ann Epidemiol.5% of patients with psoriatic arthritis also had P copri in their gut. 1996. Raes J. the physician can investigate the patient’s status by selecting the right combination of laboratory immune and autoimmune markers and initiate preventive therapy with the possibility of eliminating the cause of the immune and autoimmune reaction. Deboy RT. et al. Margolis HG. the “second brain. 7. A human gut microbial gene catalogue established by metagenomic sequencing.160(1):85-91. 2008:21(3):553-566. Multiple sclerosis patients have peripheral blood CD45RO+ B cells and increased intestinal permeability. Collins S. and other factors affect the formation of the microbiota. Autoimmune disease fact sheet. 2013.6 The oral cavity. David MR. Premature birth. 20. 3. Li R. http://www. Accessed October 16.8 Studies have shown that when the gut microbiota is changed by pharmaceutical medications. 2013.org/autoimmune-information/autoimmune-statistics/. 2006:312(5778):1355-1359. 6. McConnell R. 9. Clin Exp Allergy. et al. immunoregulation. allergies. Bienenstock J. Use ISSN#1078-6791. Avol EL. thereby triggering an autoimmune disorder.347(12):911-920.5. It contains more neurons than the spinal cord in the myenteric and submucosal plexuses. Hoffmann C. teeth. including the tongue. and clinical disease is preceded by many years by circulating autoantibodies in the peripheral blood.This article is protected by copyright. 2010. Yacyshyn B. and periodontal tissues. Bowen-Yacyshyn MB. Renz-Polster H. the large intestine is where we have the greatest number of bacteria—1013—of which 70% cannot be cultivated in the microbiology laboratory. Campbell. To share or copy this article. and endocrine mechanisms. Caesarean section delivery and the risk of allergic disorders in childhood. 12. Bach JF. and the gut. This is less in the stomach. Caesarean section versus vaginal birth. Gut .173(5):1243-1252. and mucosal blood among others. et al. Campbell—Your Gut . The colonization of the gut occurs during birth and plays an essential role in the formation of the gut microbiota. breast-feeding versus commercial formula. please visit copyright. 10. 8.aarda.com the major components of the humoral immune system and prevents bacteria from adhering to the mucosa and prevents the penetration of antigens into the internal environment. By becoming aware of the importance of the gut microbiota and the effects on the 10 ALTERNATIVE THERAPIES. Rook GA. Clin Exp Immunol. immunological. and approximately double that in the terminal ileum. 4. Antibodies as predictors of complex autoimmune diseases and cancer. Published August 29. Meddings J. visit alternative-therapies. Mode of delivery is associated with asthma and allergy occurrences in children.10 Multiple sclerosis (MS) is an autoimmune disorder that has a devastating effect on young people and leads to disability.3(2):148-158. American Autoimmune Related Diseases Association. Nature. Abt MC. Andrew W. AARDA Web site. Fasano A. Using rheumatoid arthritis as an example of an autoimmune disease triggered by changes in the gut microbiota. 2. Metagenomic analyses reveal antibioticinduced temporal and spatial changes in intestinal microbiota with associated alterations in immune cell homeostasis. Vojdani A. Mucosal Immunol. 2008.54(3):317-320. 2005. Dig Dis Sci. Hill DA.12 The symptoms of autoimmune diseases are often unclear and vague. Another interesting factor was that 37. MAR/APR 2014 VOL. Brunet LR.
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