Dysfunction of the immune system is the common denominator of diseases like Grave’s disease (GD), Hashimoto’s disease (HD), and celiac disease (CD). In addition, we can add Non-celiac wheat sensitivity to this equation. Furthermore, gut permeability caused by a damaged intestinal barrier can increase the passage of multiple pathogens. In turn, this phenomenon could result in an exacerbates immune reaction. Dysbiosis is also a common denominator of these conditions. A change in gut microbiota composition strongly influences micronutrient absorption and inflammation, affecting thyroid function.
Humans exist in symbiosis with our gastrointestinal bacteria. Nutrition, breastfeeding, birth modality, disease, medication, and stress can influence and change our gut microbiota, creating dysbiosis throughout our life.
In terms of micronutrients, gut bacteria play a modulating role in synthesizing vitamins like vitamin K, Vitamin B2, B3, B5, B6, B7, B12, and folic acid. Consequently, dysbiosis can influence the apparition of immune, digestive and mental disorders.
Gut-associated lymphatic tissue
Microbiota influences the development of the gut-associated lymphatic tissue (GALT). Furthermore, GALT contains more than 70% of the entire immune system, controlling the tolerance of self-antigens.
Regulatory T-cells (Tregs) are critical modulators of the immune response, and their number increases in the presence of elevated levels of short-chain fatty acids (SCFA). These SCFA promote the growth of healthy bacteria and are derived from dietary fiber, which shows the strong influence of nutrition and microbiota. In addition, higher levels of SCFA can lower the concentration of pro-inflammatory Th-17 cells and strengthen the tight junctions.
Common signs of immunodeficiency like reduction of T-helper cells and Treg differentiation are part of celiac disease, HT, and GD. Furthermore, this phenomenon is associated with bacterial overgrowth and increased intestinal permeability, reflecting elevated pro-inflammatory cells and a harmful impact on thyroid function.
Enzymatic conversion of T4 to T3 has also been located in the intestinal wall. Although this has only been studied in rats, it shows that microbiota can bind thyroid hormones.
Celiac disease and Non-celiac wheat sensitivity
Wheat consumption, specifically gliadin protein in gluten-containing products, promotes a CD4+ Tcell-mediated cascade. Following this first reaction, an elevation in cytokines promotes an inflammatory response leading to CD8 +T cells activation, destroying inflamed enterocytes. Furthermore, this action triggers B-cell that produce antibodies against gliadin, transglutaminase, and endomysium. This cascade ends up in an increased intestinal mucosa inflammation, villous atrophy resulting in malabsorption, intestinal permeability, and increased gastrointestinal discomfort.
On the other hand, and without the autoimmune feature, non-celiac wheat sensitivity (NCWS) can cause similar symptoms to those in celiac disease. Nevertheless, NCWS has an immune-related response coming from the innate immune system. Studies have shown increased activation of Toll-like receptors (TLR) and inflammatory markers like TNF-A occurring with NCWS.
Some of the nutrient absorption affected by these conditions are iron, vitamin D, and selenium. These nutrients are crucial for thyroid function.
In addition, the affected gut’s permeability leads to the penetration of pathogens to the immuno-reactive subepithelium, leading to autoimmunogenesis and inflammation. Zonulin plays the role of gut permeability modulator and can weaken the tight junctions of the intestinal barrier.
Autoimmune diseases are complex conditions with a common gastrointestinal feature. The role of gut permeability and dysbiosis can promote autoimmunogenesis and inflammation add up to the issue, promoting a situation that might be hard to control. In addition, the micronutrient deficiency promoted by the interaction of these mechanisms affects thyroid function and hormone synthesis. Functional or orthomolecular medicine provides a complete treatment by testing and not guessing. If all diseases start in the gut, treating dysbiosis, renewing and repairing the gut lining is the first thing we need to target.- Ana Paola Rdz. Arciniega, MS
Knezevic, Jovana et al. “Thyroid-Gut-Axis: How Does the Microbiota Influence Thyroid Function?.” Nutrients vol. 12,6 1769. 12 Jun. 2020, doi:10.3390/nu12061769
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