An autoimmune disease condition occurs when the immune system mistakenly attacks healthy cells, organs and tissues. The immune system is the body’s first line of defence to attack germs, certain viruses and bacteria. However, when the immune system gets confused, it can attack any part of the body like the skin, causing alopecia areata or the pancreas leading to type 1 diabetes. This most often also happens when an individual is already genetically predisposed to an auto-immune condition.
Treatment protocol aims at reducing inflammation and could include the use or corticosteroids. However, research is emerging on the vital role that diet plays in treating certain auto-immune conditions. Its effect is largely seen in treating digestive issues such as celiac disease and Hashimoto's thyroiditis. In an autoimmune condition, certain foods, especially those containing gluten contain antigenic substances which mimic the body's antigens in what is known as molecular mimicry. This can cause digestive issues as the body reacts against antigens and its own tissues in what is known as food autoimmune reactivity.
Gluten found in wheat, rye and barley follows this pattern of molecular mimicry and is often avoided completely if an individual has a celiac disease or a non-celiac sensitivity to gluten. Research shows that when gluten is avoided it could offer relief to those with autoimmune conditions such as- Hashimoto's thyroiditis, Irritable Bowel Syndrome [IBS], type 1 diabetes, neurodegenerative diseases and rheumatoid arthritis.
Hashimoto's thyroiditis
This condition occurs when the immune system attacks the thyroid gland and affects its ability to produce thyroid hormones, resulting in hypothyroidism. The protein gliadin found in gluten is known to have interactions with thyroid antigens. This could also affect gut health causing gut dysbiosis promoting inflammation and intestinal permeability. Balancing gut microbes is therefore vital along with eating a healthy and balanced diet. Eliminating gluten while not making other essential dietary and lifestyle changes will not help in dietary management of the health condition.
Irritable Bowel Syndrome [IBS]
IBS affects digestion and could cause discomfort which includes- stomach pain, gas, bloating, cramps and constipation and/ or diarrhoea. This is caused due to low grade gut inflammation and changes in the gut-brain axis. Being an immunogenic protein, this could activate the autoimmune component in genetically susceptible people and if the proteins are not broken down properly, it could trigger an immune response aggravating symptom of IBS. Wheat also contains carbs like fructans which may not be well absorbed and could cause bacterial fermentation which triggers bloating and digestive discomfort. IBS can also be triggered by FODMAP foods and a diet low in gluten and foods on the FODMAP list can be helpful.
Celiac disease
This is an autoimmune triggered digestive health issue and affects the intestines as in IBS.
The symptoms may also be similar, but they have different causes, triggers and treatment methods. However, Celiac disease differs in that it causes long term damage to the digestive tract, this can result in weakness and nutrient deficiencies as food isn't being properly absorbed and utilized. This is always due to an immune reaction to gluten. In such cases it is best to avoid gluten to prevent flare ups and tailor the diet to include alternate sources of carbs.
Type 1 diabetes
Those who have celiac disease are also more prone to developing type 1 diabetes, as both share similar underlying factors. Being an auto-immune condition, the immune system attacks the pancreas, which prevents it from creating insulin.
Since gluten is found in carbs, type 1 diabetics should lower their overall intake of carbs, especially the refined ones. This includes wheat and its products. Other healthy alternatives include- millets, brown rice, quinoa, oats, corn, amaranth [a pseudo cereal], sweet potato, legumes that are high in fibre [channa, rajma].
Rheumatoid arthritis
This health condition occurs when the immune system attacks the joints. Losing weight and staying fit is important to help manage rheumatoid arthritis. In addition, gluten impacts the gut microbiome which could cause inflammation in the joints. Managing RA involves eating a healthy balanced diet with fresh and brightly coloured fruits, vegetables, nuts, seeds, leafy vegetables, low fat dairy, fatty fish [cooked in a healthy way]. Supplements of omega 3 and vitamin D may also be helpful on the recommendation of a doctor.
A very important aspect that should not be overlooked is that with most auto-immune conditions the individual may have an underlying factor [genetics, environmental exposure] that can cause an adverse reaction to gluten. In themselves, foods that contain gluten also contain fiber and several nutrients. This means that you do not need to upend your entire diet and completely avoid foods that contain gluten if you do not have an autoimmune condition. Several crash or fad diets eliminate entire food groups based on the premise that gluten is ‘bad ‘for health. It is always best to take the advice of your doctor and a qualified Dietitian to make changes to your diet in a balanced, healthy and holistic way.
A note on gluten free products: These may be high in additives like sugar, salt and/ or unhealthy fat. These may also lack fibre which is not good for overall fitness. Lack of fibre could cause constipation and raise blood sugar levels.
As for auto-immune conditions, their symptoms need to be managed through a balanced lifestyle and a healthy diet. Here again, a dietitian can help you with a tailor-made diet plan. You may need to avoid certain foods for a period of time to check for symptoms. These can be gradually added back after a while, to check tolerance. This is a balanced and healthy approach.
REFERENCES:
Volta U, Pinto-Sanchez MI, Boschetti E, Caio G, De Giorgio R, Verdu EF. Dietary Triggers in Irritable Bowel Syndrome: Is There a Role for Gluten?. J Neurogastroenterol Motil 2016;22:547-557. https://doi.org/10.5056/jnm16069
Lerner A, Shoenfeld Y, Matthias T. Adverse effects of gluten ingestion and advantages of gluten withdrawal in nonceliac autoimmune disease. Nutr Rev. 2017 Dec 1;75(12):1046-1058. doi: 10.1093/nutrit/nux054. PMID: 29202198.
https://www.healthline.com/health/diabetes-and-gluten#should-i-go-glutenfree
https://www.healthline.com/health/ibs/ibs-vs-celiac#symptom-triggers
Lerner A, Benzvi C. "Let Food Be Thy Medicine": Gluten and Potential Role in Neurodegeneration. Cells. 2021 Mar 30;10(4):756. doi: 10.3390/cells10040756. PMID: 33808124; PMCID: PMC8065505.
Vojdani A. Molecular mimicry as a mechanism for food immune reactivities and autoimmunity. Altern Ther Health Med. 2015;21 Suppl 1:34-45. PMID: 25599184.