Leaky Gut and Autoimmune Disorders

By Sara Gottfried MD | August 28, 2024

Severe fatigue, brain fog, aches and pains, feelings of tingling and numbness, stubborn weight gain, abdominal pain, digestive problems, hair loss, insomnia, and even anxiety are common complaints I have heard over the years from my patients, many of whom struggle to keep their conditions under control with steroids, anti-inflammatories, pain killers, and other medications.

Most of my patients are surprised to learn that their conditions are actually symptoms of an underlying autoimmune disorder – and that it could originate in their gut.

You’ve probably heard the term “leaky gut” by now. Yes, I agree, it sounds awful, but as we take a closer look at how our immune system operates, you will understand why it is called this and why Hippocrates proclaimed some 2,000 years ago, “All disease begins in the gut.”

What Causes Autoimmune Disease?

Scientists have identified over 100 different autoimmune conditions, and this list continues to grow. Some of the well-known autoimmune diseases include rheumatoid arthritis, celiac disease, lupus, thyroiditis, multiple sclerosis, type 1 diabetes, alopecia, psoriasis, and eczema. These diseases and disorders all share a common root cause: an overactive immune system that destroys the body’s own tissues.

A healthy immune system creates antibodies against anything it deems as foreign, such as bacteria, viruses, and large particles that aren’t normally found in our bloodstream. During autoimmunity, the immune system fails to recognize its own cells and mistakenly produces antibodies against its own tissues, also known as autoantibodies. This leads to chronic inflammation and tissue destruction, pain, and loss of function.

In fact, what distinguishes one autoimmune disease from another is simply the part of the body (the type of tissue) that is under attack. For example, rheumatoid arthritis involves an autoantibody attack against the joints, whereas celiac disease involves an autoantibody attack against the intestinal cells. Regardless of the particular disease, the underlying cause is an overactive immune system, which explains why autoimmune disorders are commonly treated with steroids and other immune-suppressing medications. But why in the world would our immune system turn against us? In my book, THE AUTOIMMUNE CURE I discuss the three main triggers of autoimmunity and leaky gut is one of them.

What is Leaky Gut Syndrome?

The gut wall (that is, the lining of the intestines) is made up of a single layer of tiny cells which allow nutrients and water in while keeping bacteria, large proteins, and other toxins out. You can think of the gut wall as the bouncer of the body, giving access only to those worthy of entry while keeping the trouble makers and the “bad guys” away. Nobody likes to think about it, but the intestines are a pretty toxic place. We inadvertently swallow oodles of toxins on a daily basis, which is why a healthy gut wall is critical to maintaining strong immunity and overall good health. Apparently, Mother Nature thought so too when she placed about 70% of our immune system in and around the gut wall!¹

The scientific name for leaky gut syndrome is increased intestinal hyperpermeability, which essentially translates to “an excessively permeable intestinal lining.” When the gut wall develops tiny holes in it, it’s as if the bouncer has left the door unattended, allowing all the bad guys to flood in and cause a ruckus. Considering that the gut wall is only a thin layer of cells, it’s easy to imagine how toxins often sneak past it and find their way in to the rest of you body. This is precisely what happens when you have a leaky gut: Unwanted toxins crash your immune system and the body shuts down with inflammation.

In other words, the toxins that ordinarily stay in your intestines until they’re pooped out “leak” into your body, triggering inflammation in the tissue surrounding your gut wall. Over the short term this isn’t such a big deal, since our immune system is designed to handle short breaches in security. But over the long-term the immune system becomes overwhelmed, allowing toxins to sneak into the bloodstream, and “troll’ our systemic circulation. Through a process known as translocation, these toxins can travel to virtually any part of the body and incite an inflammatory immune response wherever they land.² This is autoimmunity.

Understanding the Role of Zonulin

Dr. Alessio Fasano’s discovery of zonulin (an endogenous molecule) marked a turning point in our scientific understanding of autoimmune disease.3 With evidence that the intestines naturally mediate their own permeability by releasing zonulin from the gut wall, researchers were finally able to gain a deeper understanding of what causes a leaky gut. As it turns out, a lot of different things can trigger this condition, such as certain medications (i.e., NSAIDS and steroids), chronic stress, alcohol, and certain foods.⁴ However, two main triggers have been identified to produce zonulin and are thought to contribute to increases in intestinal hyperpermeability in everyone who has a gut wall (not just people with autoimmune disease).^{3, 5}

The two main triggers for a leaky gut are:

Gluten and other anti-nutrients from foods
Dysbiosis – an imbalance in the body’s natural microflora (i.e. too much “bad” bacteria in the gut)

A New Theory of Autoimmune Disease

Previous theories of autoimmunity were developed before the discovery of zonulin, but they did not recognize the significant role that a leaky gut plays in autoimmune disorders. With the discovery of zonulin, Dr. Fasano proposed an updated theory of autoimmune disease, suggesting that three separate factors must be present simultaneously in order for an autoimmune disease to be active:^3,5

Genetic predisposition to autoimmune disease (that is, you carry the HLA gene)

Exposure to a trigger of zonulin production
Exposure of the trigger to the immune system, via a leaky gut

In THE AUTOIMMUNE CURE, I share a theory that is based on Dr. Fasano’s but one that also recognizes the impact of trauma on the development of autoimmune disease.

The key triad that leads to autoimmunity is:

Heredity – genetic predisposition
Increased intestinal permeability (leaky gut)
A trigger

These three factors interact with the immune system positively or negatively and ultimately initiate the cascade of events leading to autoimmune disease. Triggers can vary but range from trauma and toxic stress to infection, from poor dietary choices to big hormonal shifts like pregnancy or perimenopause.

My latest book delivers a plan to slow the development of autoimmune disease, and even reverse it by addressing the root cause of the condition and healing the body, mind, and spirit. I share advice on the following:

Elimination Diets — A diagnostic tool to identify foods that trigger the immune system
Nutritional Modulation — Four areas to address for the long term: nutrient gaps, poor digestion, toxic backlog, and blood sugar spikes
Sleep — How to measure your sleep and the eight steps to better sleep
Toxic Stress — How to manage stress and regulate cortisol with stress resilience techniques
Supplements — Immunomodulators such as black cumin, polyphenols, curcumin, resveratrol, vitamin D, omega-3 fatty acids, and more
Breathwork — Reclaim the breath as opposed to breathing on autopilot
Microbiome Restoration — Optimize the microbiome through nutrition, supplements, and more
Somatic Therapy — Therapies such as Hakomi, a form of mindfulness-based somatic therapy, also described as assisted self-study
Psychedelic Therapies — Research-backed, medically sound therapies working with trusted and experienced clinicians, such as ketamine-assisted treatment, micro dosing psilocybin, MDMA-assisted therapy, and others