food sensitivities, leaky gut & the microbiome tackling ...€¦ · the microbiome,...
TRANSCRIPT
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)
Initial
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Can we restore the microbiome?
Source: Sonnenburg et al. (2016)
Initial
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Ge
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Can we restore the microbiome?
Source: Sonnenburg et al. (2016)
Initial
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4?
Ge
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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.”