Living with Lupus

Lupus Flare-Ups and Bacterial Growth in the Gut

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A new study links changes in the gut microbiome to SLE flares.

Systemic Lupus Erythematosus (SLE) is an autoimmune disease that affects nearly every organ in the body – Like many other chronic illnesses, the symptoms can fluctuate, sometimes going down to low symptoms before suddenly ‘flaring’ up into an onslaught of pain and organ-related symptoms.

These flares are triggered by conditions and are unique to each person. Most people with lupus have a good idea of what will trigger their flares, but flares are notoriously difficult to predict. Flares can last anywhere from 2 days to several weeks, even months or years and there doesn’t seem to be a typical length, even for an individual person.

What if part of the reason for unpredictable flares was because the trigger was inside the body?

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An Interesting Microbiome Study

A new study from the New York University (NYU) Grossman School of Medicine revealed that higher levels of specific species of bacteria in the guts of women with lupus are associated with serious symptom flares.  

The study followed a total of 16 women from a variety of socioeconomic and racial backgrounds over 4 years. The association occurred in 5 of those women (30% of patients.) They were compared to 22 otherwise healthy female volunteers. 

This was confirmed by a similar study on 117 untreated patients with SLE in China, compared to 52 treated SLE patients and 115 healthy controls. 

Most of the women who were affected by the bacterial blooms often had lupus nephritis symptoms, with one having joint inflammation symptoms. The reason for this overlap of symptoms is unclear.

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What is the Microbiome?

Researchers think that part of the reason why the women experienced the flares is because the body interacts closely with the microbiome. The body reacts to its microbe companions by regulating the immune system by activating or de-activating certain genes in the DNA. 

For decades, scientists have known that the bacteria and other organisms that live in our stomach and intestines have a lot to do with how easy it is to maintain a healthy weight. This living ecosystem inside us is called the gut microbiome , and it is vital to our health. 

The gastrointestinal tract – the mouth, esophagus, stomach, and intestines – are a sensitive place for people with lupus. 

Food enters through the mouth, where it is chewed, swallowed down the esophagus, and enters the stomach, where it is digested. In the intestines, nutrients and water are absorbed into the bloodstream to be used by the body. Every part of this cycle, from the teeth in the mouth, to the muscles that move the food through the system, to the enzymes that are secreted by the body to break down the food, to the walls of the intestines that absorb nutrients and keep invading bacteria out – all of these parts can be affected by lupus. Medications can also influence how these organs work, and the bacteria that live there.

The microbiome of the gut live mainly in the small and large intestines, though some acid-tolerant bacteria can live in the stomach. The mouth also has its own microbiome, affected by the air you breathe, anything that passes through the mouth, and dental hygiene.  

In mice, just changing what species of bacteria live in their guts can drastically change their weight and health, even switching body types between mice. While gut microbiome transplants are not currently recommended for humans, we can change a lot about our microbiome by changing our diets and literally feeding it differently.

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What Species of Bacteria Was Associated With Flares?

According to the NYU study, Ruminococcus blautia gnavus was the bacteria associated with lupus flares.

Ruminococcus is a gram-positive bacterium that grows in areas that have little to no oxygen available (also known as an anaerobic bacteria.) It was named after cows, which are ruminants, where it was first discovered. 

Various species of ruminococci are an important part of the gut microbiome, though its role in the ecosystem of the gut is still mysterious (though it might be important for making sure that other “good bacteria” are able to get a foothold in the gut.) Some species might also produce antimicrobial substances that help to kill invading bacteria before they can invade the ecosystem.

So, while the bacteria is supposed to be in the gut ecosystem of both children and adults, it seems to cause trouble when its numbers suddenly increase and it takes over parts of the microbiome, known as a ‘bloom.’  The ruminococcus bacteria possibly triggered the expression of certain genes, which led to an immune system reaction that caused inflammation and the disease to flare.   

Overpopulation of R. gnavus is associated with other diseases as well, including Crohn’s disease, ulcerative colitis, ADHD, anxiety, migraines, and even epilepsy. While researchers still don’t know why, it’s clear that R. gnavus is an important part of the ecosystem with huge effects on the body. It’s even been associated with the development of childhood allergies, implying that it plays a key role in modulating the immune system’s responses.

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How to Take Care of the Microbiome

We still don’t know all of the benefits that our gut microbiome gives us, but we know that it is important. And, for people with lupus, maintaining the health of their gut microbiome could reduce their symptoms and flares.

Eating foods rich in fiber, omega 3 fatty acids, vitamin b and vitamin A will help the gut microbiome thrive.

Trying probiotics  – which are natural sources of the bacteria in a healthy microbiome to shore up the populations in the gut – might also be beneficial to the gut microbiome. Some studies indicate that they could directly help reduce inflammation in the kidneys of female patients with lupus. Obviously, the studies are small, so take it with a grain of salt, but according to a Lupuscorner survey, 75% of the people who tried probiotics found them to be helpful in reducing their symptoms and improving their health – so incorporating probiotics could be worth it. 

Low carbohydrate and low-fat diets are, overall, linked to healthier bacteria in the gut. Low-processed diets such as the autoimmune protocol diet https://lupuscorner.com/autoimmune-protocol-diet-aip-for-lupus/ or the Mediterranean diet are also beneficial to the gut microbiome. 

Excess sugar can, conversely, make the microbiome less healthy in the gut in addition to the other problems that excess sugar causes. The microbiome in the mouth is linked to the gut, too (through swallowing, in good part,) and sugar has a huge effect on this microbiome as well.

Celiac disease is a potential issue for people with lupus and their guts so it is also worth looking into, just to be sure.

In all cases, be sure to bring up any diet or treatment options with your doctor before making any major changes as they may be aware of alternative treatments or potential interaction effects.

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A Lupus Warrior’s Takeaway

People with lupus have unstable microbiomes, scientists conclude, though it’s unclear whether it’s a cause of the disease or an effect of the disease. It is clear that it, at the very least, is involved in a feedback loop where they end up affecting each other, so treating the disease and taking care of the microbiome will improve health overall.

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