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

>> Dr. Terry Simpson: Hey, welcome back to Fork U Fork University, where

we make sense of the badness, bust a few myths and show

you how food may not be medicine, but it is

important. I am your chief medical

explanationist and host, doctor Terry Simpson.

Today we're going to tackle the topic that is both timely

and critical. We're going to talk about why

chiropractors and other functional medicine practitioners

take stool samples and recommend rather

restrictive diets for autoimmune disease like Hashimoto's

thyroiditis, rheumatoid arthritis and

others. Let's start with the simple truth.

Autoimmune diseases are complex,

chronic conditions that require careful

management. Conditions like Hashimoto's

thyroiditis, where the immune system attacks the thyroid

gland leading to hypothyroidism, are

not easily fixed by dietary changes

or gut health gimmicks. Yet there are people

out there, often without a medical degree,

claiming they can diagnose and treat these

serious conditions by analyzing your

stool or putting you on a restrictive

diet. Let me be clear, these

folks are quacks.

Now don't get me wrong. Diet does

play a role in your health, and there's growing

evidence that our gut microbiome is important to

overall well being. But when it comes to autoimmune

disease, the science is far more

nuanced than what these so called experts would have

you believe. Let's break it down.

First, let's talk about the chiropractors and other

alternative health practitioners who claim they

can diagnose autoimmune diseases

and their treatments by analyzing stool

samples. The idea here is by looking at the

bacteria in your gut, they can identify

imbalances or what we call

dysbiosis, which claims to be the root

cause of your autoimmune disease.

They will tell you by adjusting your gut bacteria,

usually with expensive probiotics, supplements

and restrictive diets, you can cure or

manage your disease. Heres the problem.

While its true that our gut microbiome influences

many aspects of our health, the science

of specific gut bacteria to

autoimmune disease is in its

infancy. We do not yet have a

clear understanding of how to manipulate the gut

microbiome and treat autoimmune

diseases effectively. The studies

that do exist are often preliminary,

done with mice or rats, or based

on small sample sizes of human beings,

and to extrapolate that limited amount of

data into broad claims that gut health

can cure or significantly

change autoimmune disease is just

not only premature, it's

irresponsible. I'll give you an example.

A study published in Nature Reviews Immunology in

2015, highlighted the complexity

of gut immune interaction and noted

that the gut microbiome likely plays a role

in the development of autoimmune disease, but we are far

from understanding how to target it for treatment.

More recent research, such as that from the Journal of

Autoimmunology in 2021

supports that view, acknowledging that

while gut dysbiosis is associated with

autoimmune conditions, there is no one size fits

all pattern, no one solution to fixing it

through diets or gut probiotics.

Furthermore, recent

studies show that stool samples

may not be helpful in termining the

gut microbiome, especially in the context of

determining autoimmune disease. A study by Lew

et al found that fecal bacteria

significantly different from the swab and tissue

microbiota in patients with irritable bowel

syndrome versus if we lavage the

gut with like a colonoscopy so we can get

truer to where anatomically

the gut microbiome is. Let's be clear,

the chiris factors will have you take a stool sample.

However, the microbacteria which are in your

gut that might be affecting it are going to be

completely different if you go up further into the colon,

as if you use a colonoscopy.

Leviathan et al demonstrated stool samples

are a poor proxy for what we call

the inner colonic microbiome, or the bacteria of your

gut. Their study showed that those samples that were

taken very carefully significantly

differ from those in a stool sample.

It's just not the same

thing. So in summary, stool samples may not be

helpful for determining gut microbiome, as if gut

microbiome could actually fix autoimmune

diseases. So when someone takes

your stool sample and say they can cure your

hashimoto's or your lupus or your rheumatoid

arthritis by tweaking your diet and selling you rather

expensive stuff, theyre selling you

snake oil. The truth is, managing

autoimmune diseases requires a

multifaceted approach and typically involves

medications such as synthetic thyroid hormone. In the case of

Hashimoto's and close monitoring by

healthcare professionals, this is something that these

people have no clinical idea about. They weren't

trained clinically. Let's be clear, a

chiropractor doesn't have the extensive

clinical training that

a physician does. Consider this. Your average medical

student not only spends two years studying basic clinical

medicine in a textbook, they then go on to the wards

of hospitals where they see the most complex

patients on the planet treated by the most

well known physicians on the wards, then they

go out and do a three year internal

medicine internship in some of the brightest

hospitals in the nation, taught by some of the best scientists.

Then they go on to do a fellowship in rheumatology.

Compare that to a chiropractor who has two years

of neck cracking. Let's move on.

Let's talk about the restrictive diets that are pushed by these

practitioners. You've probably heard of the autoimmune protocol,

or the AIP diet, which eliminates a wide

range of foods, from grains and legumes to

nightshades, dairy, eggs, nuts and seeds.

The idea is that these foods could trigger some

immune response, and by eliminating them, you can reduce

inflammation and manage your autoimmune disease. Sounds

promising, right? The problem is that the AIP

diet is based on very, very weak

science. While some people report

feeling better on these diets, we have to ask,

why? Is it limited by their eliminating

food groups? Or is it simply

that their disease comes and

goes, relapses, returns,

goes into remission, which is the nature of

autoimmune disease. Let's look at a study published

in nutrients in 2017. They looked at the

AIP diet in the context of inflammatory bowel

disease, another autoimmune disease, and found that while

some patients experienced symptomatic

relief, the study was small, lacked the control.

Group, couldn't possibly say it was the AIP diethouse,

etcetera. There are other

diets that are used for this. Typically what they will do is, let's

eliminate dairy. I can tell you, based on

what we have seen and has been told to us, that

their formula comes down to this. Besides selling you the

really expensive supplements, the really expensive

probiotics for which there is zero, and I

mean zero evidence, they will tell you to

eliminate dairy, eliminate gluten, and

go on one of these highly restrictive diets, like, oh,

the whole 30 diet or the AIP diet, and

then they'll say, look, you're cured.

Let's be very clear.

When you have a relapsing disease like

rheumatoid arthritis, you are going to

have times when it's going to relapse for unknown reasons. It's not your

gut microbiome. it will just does it over

time. And if you have rheumatoid arthritis aren't

getting appropriate clinical medicine,

you will end up with more joint destruction and more

problems. And let's put it this way, once the

chiropractors have you out of their office, they're not going to

be able to follow your inflammation. They're not going to be able to

follow your joint destruction. They

don't care. They just want to sell you

their exceedingly expensive tests, which cost up to

dollar 500 for a stool sample, and their supplements,

which are like $90 a point at each.

So what's the bottom line? When it comes to

autoimmune diseases? Beware of anyone who promises a

cure or significant management from

diet and supplements alone. The science

simply doesn't support these claims.

Instead, focus on working with a

qualified healthcare provider. If you have a

rheumatologic disease, see a board certified

rheumatologist. If you have a problem with your

thyroid, see a board certified

endocrinologist. Because these non qualified

nurses, dentists and chiropractors who get their

little functional medicine degree, which by the way, they focus

on thyroid disease and they focus poorly on

it, they simply don't lack the clinical

experience, the comprehensive literature knowledge,

and they end up keeping people from

having support, the support you need

for an exceedingly complex medical

problem. Alright,

managing autoimmune diseases is a

marathon. It's not a sprint. It

requires thoughtful, multifaceted

approach, not a quick fix. Don't let

those quacks steer you off courses with

promises far too good to be

true. I hope today's episode has shed a

little light on the dangers of these so called miracle cures with

miracle diets and the quackery. That

sounds too good. This reminds me of one thing

else. Do you remember when chiropractors

used to say the cure of all their diseases is in

sublaxations of the spine, which they could never

see, could never demonstrate, and spent years telling you to come back

every week? Now they're going to the gut. They can't

see it. They have sort of a science y test, and they are trying to

convince you they alone have the answer to the root cause

of disease, as opposed to all of the

people who seriously study this and follow their

patients intently and publish in the

literature, the only root cause of

disease that these functional medicine practitioners have

found is your wallet. I would be

careful of them. See board certified people to make

sure thanks for joining me on this episode of

fork you where we try to make sense of the madness.

I'm your host, doctor Terry Simpson. This has been written and

researched by me and you can find references for

this to for those of you who like it on the blog

associated with this, which is called

yourdoctorsorders.com or four

q.com dot. I want to thank the people who are

distributing this, our friends at Simpler media, the pod God, Mister

Evotera. And of course, I couldn't

produce this without my favorite producer in the world,

from producer girl Productions. Thanks for listening. We'll

see you later.

Hey, Ivo, did you ever find some sort of

thing that we could use to, cure everything in that herb garden of

yours?

>> Emily: Ivo is on vacation in Portugal. Terry, this is

Emily filling in for him on the podcasting front, but he

didn't mention anything about watering his plants.