Episode 55
Autoimmune Diseases and Charlatans
The Cyclical Nature of Autoimmune Diseases: A Huckster's Playground
Autoimmune diseases are notoriously difficult to manage because they don’t follow a linear progression. Patients often experience periods of remission, where symptoms lessen or disappear, followed by flare-ups, where symptoms return, sometimes worse than before. This cyclical nature gives the illusion that certain "treatments" or lifestyle changes are working when, in reality, the disease is simply following its natural course.
Hucksters exploit this ebb and flow, offering unproven solutions and claiming credit for any improvements that coincide with the natural remission phase. When symptoms return during a flare-up, they may shift the blame to the patient, suggesting they didn’t follow the regimen properly or need to try an even more restrictive approach.
In many cases, these alternative therapies center around the idea that gut issues cause autoimmune diseases, particularly leaky gut syndrome. The pitch is simple: repair the gut, and the immune system will stop attacking the body. Unfortunately, the science doesn’t back this up.
Why the Gut Isn’t the Root Cause of Autoimmune Disease
It's true that there is a connection between the gut and the immune system. In fact, about 70% of the immune system resides in the gut, and gut bacteria (the microbiome) play a role in regulating immune responses. However, autoimmune diseases are far more complex than just a gut issue.
Genetic predispositions primarily drive Autoimmune diseases, environmental triggers, and immune system dysregulation. While diet and gut health can influence immune responses, there’s no evidence that simply "healing" the gut will reverse the course of autoimmune diseases. The immune system in these conditions has gone awry in ways that are not fully understood, and current medical treatments focus on suppressing overactive immune responses and managing symptoms—not on gut health alone.
Myasthenia Gravis (MG) is an autoimmune disease where medical treatment significantly outperforms dietary interventions.
MG is characterized by autoantibodies targeting the neuromuscular junction, leading to fluctuating muscle weakness and fatigability. The primary treatment modalities for MG involve immunosuppressive therapies and precision medicine approaches.
Current treatment guidelines, as discussed by Cavalcante et al., highlight the use of immunosuppressive therapies such as corticosteroids, azathioprine, and mycophenolate mofetil to control symptoms and improve muscle strength. (reference here)
Additionally, novel biological drugs targeting B cell activation, antibody recycling, and complement system-mediated neuromuscular junction damage have shown efficacy and safety in clinical trials. These precision medicine approaches are tailored to the patient's specific immunopathogenic mechanisms, offering a more targeted and effective treatment strategy.
In contrast, dietary interventions have not demonstrated significant efficacy in managing MG. While general nutritional support is important for overall health, there is no specific diet that can modulate the autoimmune mechanisms underlying MG to the same extent as pharmacological treatments.
In summary, medicine does better than diet in managing Myasthenia Gravis, with immunosuppressive therapies and precision medicine approaches being the cornerstone of treatment.[1]
Here’s why relying on gut health as the sole solution is like using a garden hose to fight a forest fire:
A. The Complexity of Autoimmune Dysregulation
Autoimmune diseases involve dysregulation at multiple levels of the immune system. In diseases like lupus or multiple sclerosis, immune cells are mistaking the body's own tissues for foreign invaders. This misidentification isn’t simply the result of a leaky gut; it’s a deeper issue with how the body’s T-cells, B-cells, and other immune components are functioning.
Medical treatments for autoimmune conditions, such as biologics and immunosuppressants, target these complex pathways to reduce inflammation and prevent further tissue damage. These therapies are carefully designed to modulate specific immune processes—something that diet and gut health alone can’t achieve.
B. Gut Health Cannot Reverse Severe Immune Attacks
Imagine trying to put out a raging forest fire with a garden hose—that’s what focusing solely on gut health is like when trying to manage autoimmune flare-ups. Autoimmune diseases can cause severe damage to the organs, such as the joints, kidneys, or central nervous system, depending on the condition. These diseases are often life-altering and, in severe cases, life-threatening.
Even if the gut plays some role in immune regulation, "fixing" the gut doesn’t address the immune attacks happening in vital organs throughout the body. Managing an autoimmune condition requires powerful treatments that target these immune responses at the source, not superficial changes to the digestive system.
C. Gut-Focused Diets Can Be Restrictive and Harmful
Another major issue with the gut-healing approach is that it often involves restrictive diets that cut out whole food groups in the name of reducing inflammation or healing the gut lining. These diets, such as the autoimmune protocol (AIP) or extreme versions of the paleo diet, are promoted as cures but lack strong scientific backing.
For many patients, these diets can lead to nutrient deficiencies, unnecessary food anxiety, and added stress—none of which is helpful when managing a chronic condition. Worse, some people may forego or delay important medical treatments, opting instead for these restrictive, gut-healing diets in hopes of a cure. This can lead to uncontrolled disease progression and irreversible damage to organs.
What We Do Know: The Gut’s Role in Autoimmune Disease Management
This isn’t to say the gut has no role in autoimmune disease—far from it. Gut health can influence overall health, including the immune system, and managing autoimmune diseases often includes dietary adjustments to improve symptom management. But diet should be seen as one tool in a larger toolbox, not the magic bullet.
For example:
Probiotics and prebiotics may support gut health and help modulate immune responses in some cases, though the evidence is still emerging.
However, if these patients are not appropriately followed, they can develop kidney involvement leading to loss of function or severe joint destruction for RA type, or even severe vasculitis, and none of these conditions are treated by or recognized by chiropractors
Transcript
>> Dr. Terry Simpson: Hey, welcome back to Fork U Fork University, where
Speaker:we make sense of the badness, bust a few myths and show
Speaker:you how food may not be medicine, but it is
Speaker:important. I am your chief medical
Speaker:explanationist and host, doctor Terry Simpson.
Speaker:Today we're going to tackle the topic that is both timely
Speaker:and critical. We're going to talk about why
Speaker:chiropractors and other functional medicine practitioners
Speaker:take stool samples and recommend rather
Speaker:restrictive diets for autoimmune disease like Hashimoto's
Speaker:thyroiditis, rheumatoid arthritis and
Speaker:others. Let's start with the simple truth.
Speaker:Autoimmune diseases are complex,
Speaker:chronic conditions that require careful
Speaker:management. Conditions like Hashimoto's
Speaker:thyroiditis, where the immune system attacks the thyroid
Speaker:gland leading to hypothyroidism, are
Speaker:not easily fixed by dietary changes
Speaker:or gut health gimmicks. Yet there are people
Speaker:out there, often without a medical degree,
Speaker:claiming they can diagnose and treat these
Speaker:serious conditions by analyzing your
Speaker:stool or putting you on a restrictive
Speaker:diet. Let me be clear, these
Speaker:folks are quacks.
Speaker:Now don't get me wrong. Diet does
Speaker:play a role in your health, and there's growing
Speaker:evidence that our gut microbiome is important to
Speaker:overall well being. But when it comes to autoimmune
Speaker:disease, the science is far more
Speaker:nuanced than what these so called experts would have
Speaker:you believe. Let's break it down.
Speaker:First, let's talk about the chiropractors and other
Speaker:alternative health practitioners who claim they
Speaker:can diagnose autoimmune diseases
Speaker:and their treatments by analyzing stool
Speaker:samples. The idea here is by looking at the
Speaker:bacteria in your gut, they can identify
Speaker:imbalances or what we call
Speaker:dysbiosis, which claims to be the root
Speaker:cause of your autoimmune disease.
Speaker:They will tell you by adjusting your gut bacteria,
Speaker:usually with expensive probiotics, supplements
Speaker:and restrictive diets, you can cure or
Speaker:manage your disease. Heres the problem.
Speaker:While its true that our gut microbiome influences
Speaker:many aspects of our health, the science
Speaker:of specific gut bacteria to
Speaker:autoimmune disease is in its
Speaker:infancy. We do not yet have a
Speaker:clear understanding of how to manipulate the gut
Speaker:microbiome and treat autoimmune
Speaker:diseases effectively. The studies
Speaker:that do exist are often preliminary,
Speaker:done with mice or rats, or based
Speaker:on small sample sizes of human beings,
Speaker:and to extrapolate that limited amount of
Speaker:data into broad claims that gut health
Speaker:can cure or significantly
Speaker:change autoimmune disease is just
Speaker:not only premature, it's
Speaker:irresponsible. I'll give you an example.
Speaker:A study published in Nature Reviews Immunology in
Speaker:2015, highlighted the complexity
Speaker:of gut immune interaction and noted
Speaker:that the gut microbiome likely plays a role
Speaker:in the development of autoimmune disease, but we are far
Speaker:from understanding how to target it for treatment.
Speaker:More recent research, such as that from the Journal of
Speaker:Autoimmunology in 2021
Speaker:supports that view, acknowledging that
Speaker:while gut dysbiosis is associated with
Speaker:autoimmune conditions, there is no one size fits
Speaker:all pattern, no one solution to fixing it
Speaker:through diets or gut probiotics.
Speaker:Furthermore, recent
Speaker:studies show that stool samples
Speaker:may not be helpful in termining the
Speaker:gut microbiome, especially in the context of
Speaker:determining autoimmune disease. A study by Lew
Speaker:et al found that fecal bacteria
Speaker:significantly different from the swab and tissue
Speaker:microbiota in patients with irritable bowel
Speaker:syndrome versus if we lavage the
Speaker:gut with like a colonoscopy so we can get
Speaker:truer to where anatomically
Speaker:the gut microbiome is. Let's be clear,
Speaker:the chiris factors will have you take a stool sample.
Speaker:However, the microbacteria which are in your
Speaker:gut that might be affecting it are going to be
Speaker:completely different if you go up further into the colon,
Speaker:as if you use a colonoscopy.
Speaker:Leviathan et al demonstrated stool samples
Speaker:are a poor proxy for what we call
Speaker:the inner colonic microbiome, or the bacteria of your
Speaker:gut. Their study showed that those samples that were
Speaker:taken very carefully significantly
Speaker:differ from those in a stool sample.
Speaker:It's just not the same
Speaker:thing. So in summary, stool samples may not be
Speaker:helpful for determining gut microbiome, as if gut
Speaker:microbiome could actually fix autoimmune
Speaker:diseases. So when someone takes
Speaker:your stool sample and say they can cure your
Speaker:hashimoto's or your lupus or your rheumatoid
Speaker:arthritis by tweaking your diet and selling you rather
Speaker:expensive stuff, theyre selling you
Speaker:snake oil. The truth is, managing
Speaker:autoimmune diseases requires a
Speaker:multifaceted approach and typically involves
Speaker:medications such as synthetic thyroid hormone. In the case of
Speaker:Hashimoto's and close monitoring by
Speaker:healthcare professionals, this is something that these
Speaker:people have no clinical idea about. They weren't
Speaker:trained clinically. Let's be clear, a
Speaker:chiropractor doesn't have the extensive
Speaker:clinical training that
Speaker:a physician does. Consider this. Your average medical
Speaker:student not only spends two years studying basic clinical
Speaker:medicine in a textbook, they then go on to the wards
Speaker:of hospitals where they see the most complex
Speaker:patients on the planet treated by the most
Speaker:well known physicians on the wards, then they
Speaker:go out and do a three year internal
Speaker:medicine internship in some of the brightest
Speaker:hospitals in the nation, taught by some of the best scientists.
Speaker:Then they go on to do a fellowship in rheumatology.
Speaker:Compare that to a chiropractor who has two years
Speaker:of neck cracking. Let's move on.
Speaker:Let's talk about the restrictive diets that are pushed by these
Speaker:practitioners. You've probably heard of the autoimmune protocol,
Speaker:or the AIP diet, which eliminates a wide
Speaker:range of foods, from grains and legumes to
Speaker:nightshades, dairy, eggs, nuts and seeds.
Speaker:The idea is that these foods could trigger some
Speaker:immune response, and by eliminating them, you can reduce
Speaker:inflammation and manage your autoimmune disease. Sounds
Speaker:promising, right? The problem is that the AIP
Speaker:diet is based on very, very weak
Speaker:science. While some people report
Speaker:feeling better on these diets, we have to ask,
Speaker:why? Is it limited by their eliminating
Speaker:food groups? Or is it simply
Speaker:that their disease comes and
Speaker:goes, relapses, returns,
Speaker:goes into remission, which is the nature of
Speaker:autoimmune disease. Let's look at a study published
Speaker:in nutrients in 2017. They looked at the
Speaker:AIP diet in the context of inflammatory bowel
Speaker:disease, another autoimmune disease, and found that while
Speaker:some patients experienced symptomatic
Speaker:relief, the study was small, lacked the control.
Speaker:Group, couldn't possibly say it was the AIP diethouse,
Speaker:etcetera. There are other
Speaker:diets that are used for this. Typically what they will do is, let's
Speaker:eliminate dairy. I can tell you, based on
Speaker:what we have seen and has been told to us, that
Speaker:their formula comes down to this. Besides selling you the
Speaker:really expensive supplements, the really expensive
Speaker:probiotics for which there is zero, and I
Speaker:mean zero evidence, they will tell you to
Speaker:eliminate dairy, eliminate gluten, and
Speaker:go on one of these highly restrictive diets, like, oh,
Speaker:the whole 30 diet or the AIP diet, and
Speaker:then they'll say, look, you're cured.
Speaker:Let's be very clear.
Speaker:When you have a relapsing disease like
Speaker:rheumatoid arthritis, you are going to
Speaker:have times when it's going to relapse for unknown reasons. It's not your
Speaker:gut microbiome. it will just does it over
Speaker:time. And if you have rheumatoid arthritis aren't
Speaker:getting appropriate clinical medicine,
Speaker:you will end up with more joint destruction and more
Speaker:problems. And let's put it this way, once the
Speaker:chiropractors have you out of their office, they're not going to
Speaker:be able to follow your inflammation. They're not going to be able to
Speaker:follow your joint destruction. They
Speaker:don't care. They just want to sell you
Speaker:their exceedingly expensive tests, which cost up to
Speaker:dollar 500 for a stool sample, and their supplements,
Speaker:which are like $90 a point at each.
Speaker:So what's the bottom line? When it comes to
Speaker:autoimmune diseases? Beware of anyone who promises a
Speaker:cure or significant management from
Speaker:diet and supplements alone. The science
Speaker:simply doesn't support these claims.
Speaker:Instead, focus on working with a
Speaker:qualified healthcare provider. If you have a
Speaker:rheumatologic disease, see a board certified
Speaker:rheumatologist. If you have a problem with your
Speaker:thyroid, see a board certified
Speaker:endocrinologist. Because these non qualified
Speaker:nurses, dentists and chiropractors who get their
Speaker:little functional medicine degree, which by the way, they focus
Speaker:on thyroid disease and they focus poorly on
Speaker:it, they simply don't lack the clinical
Speaker:experience, the comprehensive literature knowledge,
Speaker:and they end up keeping people from
Speaker:having support, the support you need
Speaker:for an exceedingly complex medical
Speaker:problem. Alright,
Speaker:managing autoimmune diseases is a
Speaker:marathon. It's not a sprint. It
Speaker:requires thoughtful, multifaceted
Speaker:approach, not a quick fix. Don't let
Speaker:those quacks steer you off courses with
Speaker:promises far too good to be
Speaker:true. I hope today's episode has shed a
Speaker:little light on the dangers of these so called miracle cures with
Speaker:miracle diets and the quackery. That
Speaker:sounds too good. This reminds me of one thing
Speaker:else. Do you remember when chiropractors
Speaker:used to say the cure of all their diseases is in
Speaker:sublaxations of the spine, which they could never
Speaker:see, could never demonstrate, and spent years telling you to come back
Speaker:every week? Now they're going to the gut. They can't
Speaker:see it. They have sort of a science y test, and they are trying to
Speaker:convince you they alone have the answer to the root cause
Speaker:of disease, as opposed to all of the
Speaker:people who seriously study this and follow their
Speaker:patients intently and publish in the
Speaker:literature, the only root cause of
Speaker:disease that these functional medicine practitioners have
Speaker:found is your wallet. I would be
Speaker:careful of them. See board certified people to make
Speaker:sure thanks for joining me on this episode of
Speaker:fork you where we try to make sense of the madness.
Speaker:I'm your host, doctor Terry Simpson. This has been written and
Speaker:researched by me and you can find references for
Speaker:this to for those of you who like it on the blog
Speaker:associated with this, which is called
Speaker:yourdoctorsorders.com or four
Speaker:q.com dot. I want to thank the people who are
Speaker:distributing this, our friends at Simpler media, the pod God, Mister
Speaker:Evotera. And of course, I couldn't
Speaker:produce this without my favorite producer in the world,
Speaker:from producer girl Productions. Thanks for listening. We'll
Speaker:see you later.
Speaker:Hey, Ivo, did you ever find some sort of
Speaker:thing that we could use to, cure everything in that herb garden of
Speaker:yours?
Speaker:>> Emily: Ivo is on vacation in Portugal. Terry, this is
Speaker:Emily filling in for him on the podcasting front, but he
Speaker:didn't mention anything about watering his plants.
