There has been a significant increase in the incidence of autoimmune disorders over the past several decades. Currently for every 1000 Americans between one and five people have type 1 diabetes. Type 1 diabetes typically develops when the body's own immune system attacks the pancreas and prevents the production of insulin.

There has been increasing evidence of the correlation between the gut and type I diabetes. Alessio Fasano MD brought this to everyones attention in his article Surprises from Celiac Disease (Scientific American August 2009) where he discussed the role of zonulin in intestinal permeability and in many autoimmune diseases such as celiac disease type I diabetes MS and rheumatoid arthritis.

Now according to a study published last week in the Journal of Clinical Endocrinology & Metabolism researchers demonstrated that patients with type 1 diabetes exhibit a specific inflammatory profile and microbiome composition that are different from healthy individuals (as well as from those with other autoimmune conditions) suggesting the guts potential role in the development of type I diabetes.

This is the first study to analyze the inflammatory profile gut microbiome and their association on duodenal mucosa of patients with type I diabetes in comparison with patients with celiac disease and healthy individuals.

In the study researchers examined the microbiome of 54 individuals who underwent endoscopies and biopsies of the small intestine. The participants with type 1 diabetes showed significantly more inflammation of the gastrointestinal mucosa associated with 10 specific genes which was different than the participants with celiac disease and the healthy individuals. This may result in an increased antigenic load causing altered immune activation and intestinal inflammation that may contribute to the destruction of pancreatic I² cells. In addition those with type 1 diabetes also had a distinct microbiome composition from the other two groups exhibiting a decrease in Proteobacteria and an increase in Firmicutes bacteria. 

Autoimmunity can occur in several different ways. First there can be a mistaken identity and the body attacks itself. This can occur with a virus where there is tissue destruction and it appears to be foreign to the body. The second way is called molecular mimicry. This occurs when the body makes an antibody (a protein that attacks objects in the body that appear to be foreign) to a specific antigen. These antigens can resemble certain proteins and the antibodies attack the bodys own tissues. Third is the development of the T cells (the immune system). This can be affected by genetics stress and environmental triggers.

Environmental triggers are what integrative doctors mainly work with in functional medicine. These can be food triggers such as gluten or food sensitivities that can trigger inflammation as well as anything that enters the body along with the food such as toxins or molds. In addition the nutrient status of the patient is a vital component for practitioners to evaluate. This can be antioxidant status vitamins essential fatty acids vitamin D etc. We must also look at gut health. This includes leaky gut and dysbiosis. Finally there are toxins that can affect the status of the immune system such as heavy metals and xenobiotics as well as the total toxic burden in the body.

It has not been determined if type 1 diabetes' signature effect on the gut is caused by or is the result of the body's own attacks on the pancreas but it is essential to investigate these factors for all patients with autoimmunity.

By Michael Jurgelewicz DC DACBN DCBCN CNS

Source: Lorenzo Piemonti et al. Duodenal mucosa of patients with type 1 diabetes shows distinctive inflammatory profile and microbiota. Journal of Clinical Endocrinology & Metabolism January 2017 DOI: 10.1210/jc.2016-3222