Quick answer: Research suggests a weakened gut barrier may play a role in some autoimmune diseases. When the barrier is more permeable, the immune system is exposed to more bacterial and food particles, which may encourage inflammation in genetically susceptible people. Links have been studied in celiac disease, inflammatory bowel disease, rheumatoid arthritis and multiple sclerosis.
Key takeaways
Autoimmune conditions occur when the immune system mistakenly attacks healthy tissue.
Researchers have proposed the gut barrier as a third factor in autoimmunity, alongside genetics and environmental triggers, and celiac disease shows that link most clearly.
If you have an autoimmune condition, the article recommends working with your medical team, keeping prescribed care and considering celiac screening.
What are autoimmune diseases?
Autoimmune diseases occur when the immune system mistakenly attacks healthy tissue. They can affect one or many organs and range from mild to life-threatening.
Autoimmune conditions studied in relation to gut permeability
Celiac disease
The immune system reacts to gluten, a protein in wheat, barley and rye, damaging the small intestine lining.
Inflammatory bowel disease (IBD)
Crohn’s disease and ulcerative colitis cause chronic inflammation of the digestive tract.
Rheumatoid arthritis (RA)
RA mainly affects the joints and can cause body-wide inflammation. See arthritis.
Multiple sclerosis (MS)
MS affects the brain, spinal cord and optic nerves.
How autoimmunity develops
Genetic predisposition plus environmental triggers is the traditional model. Researchers have proposed the gut barrier as a third factor: increased permeability may allow immune exposure that, in susceptible people, contributes to autoimmunity.
Supporting your gut if you have an autoimmune condition
Work with your medical team and keep prescribed treatment, and get screened for celiac disease if you have another autoimmune condition. Address gut triggers (see causes of leaky gut), and support thyroid health if relevant (see TPO antibodies).
Gut, immunity and healthy aging
Immune regulation changes with age, and chronic inflammation rises. A healthy gut barrier and microbiome help keep the immune system balanced.
When to see a naturopathic doctor
It may be time to see a naturopathic doctor if you have ongoing bloating, gas, diarrhea or constipation, or food reactions that seem to be multiplying. The same is true if you have fatigue, skin flares or joint aches alongside gut symptoms, if you want a personalized gut plan instead of guessing, or if you have an autoimmune condition and gut symptoms.
See a medical provider promptly for blood in your stool, black stools, unexplained weight loss, persistent vomiting, severe abdominal pain, fever, or trouble swallowing.
What the research shows
Some of the strongest human data linking gut permeability and autoimmunity come from type 1 diabetes research. In a 2006 study by Sapone and colleagues, 42% of 339 people with type 1 diabetes (141 people) had high blood levels of zonulin, a protein that loosens the junctions between gut cells, and higher zonulin went along with higher measured gut permeability. In stored blood samples, raised zonulin appeared about 3.5 years before diabetes developed in those who went on to get it. This shows an association in a subgroup, not that permeability causes the disease.
Celiac disease offers a test of the idea. In a 2015 randomized, double-blind trial by Leffler and colleagues, 342 adults with celiac disease who still had symptoms despite at least a year on a gluten-free diet took larazotide acetate, an experimental drug that tightens gut junctions, or a placebo for 12 weeks. The lowest dose (0.5 mg three times a day) reduced symptoms compared with placebo and gave 26% fewer symptomatic days, but the higher doses did no better than placebo. Larazotide is not an approved product, and these mixed results show how much is still unknown.
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Questions to bring to your clinician
These questions can help you get the most out of your next visit.
Given my autoimmune history, should I be screened for celiac disease or other gut issues?
Could my gut health be playing a part in my autoimmune condition?
Which gut-supportive steps would fit alongside my current care?
Would any labs help us track my autoimmune markers over time?
Frequently asked questions
Does leaky gut cause autoimmune disease?
It has not been proven to cause it. It may be one contributing factor in susceptible people.
Which autoimmune diseases are linked to gut health?
Celiac disease, IBD, RA and MS have been studied.
Should I avoid gluten if I have an autoimmune condition?
Get tested for celiac disease first, then discuss a trial with your provider.
Can gut care replace my medication?
No. It complements medical treatment.
Sources
- Sapone A, de Magistris L, Pietzak M, et al. Zonulin upregulation is associated with increased gut permeability in subjects with type 1 diabetes and their relatives. Diabetes 2006. PMID: 16644703. https://pubmed.ncbi.nlm.nih.gov/16644703/
- Leffler DA, Kelly CP, Green PH, et al. Larazotide acetate for persistent symptoms of celiac disease despite a gluten-free diet: a randomized controlled trial. Gastroenterology 2015. PMID: 25683116. https://pubmed.ncbi.nlm.nih.gov/25683116/
- Mu Q, et al. Leaky Gut As a Danger Signal for Autoimmune Diseases. Front Immunol 2017. PMID: 28588585. https://pmc.ncbi.nlm.nih.gov/articles/PMC5440529/
- Rubio-Tapia A, et al. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol 2013. PMID: 23609613. https://pmc.ncbi.nlm.nih.gov/articles/PMC3706994/
- Fasano A. Leaky gut and autoimmune diseases. Clin Rev Allergy Immunol 2012. PMID: 22109896. https://pubmed.ncbi.nlm.nih.gov/22109896/
- MedlinePlus: Autoimmune Diseases
This article is for educational purposes only and is not medical advice. It does not replace an individual evaluation. Talk with your healthcare provider before starting supplements or changing medications, especially if you are pregnant, nursing, or managing a health condition.
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