An Integrative and Functional Nutrition Approach to Pediatric Autoimmunity

September 8th, 2024

While once thought of as rare, pediatric autoimmune diseases are now diagnosed much more frequently. It’s estimated that up to 10% of kids in developed nations are impacted by various autoimmune disorders like type 1 diabetes, celiac disease, psoriasis, inflammatory bowel disease, juvenile idiopathic arthritis, and eosinophilic esophagitis1.

Nutrition is front and center in the treatment plan for kids with type 1 diabetes and celiac disease. But the power of nutrition and lifestyle may be underappreciated when it comes to other pediatric autoimmune disorders.

In this article, we’ll share a primer on the immune system, the important role gut health may play in autoimmune disease development, and how IFNCP Functional Nutritionists employ the Integrative and Functional Nutrition Academy STAIN© model to create a nutrition care plan for kids with autoimmunity.

Pediatric Autoimmunity

The innate and adaptive immune systems keep you safe from the outside world (environmental toxins and unfriendly microbes) and ensure that your own rogue cells don’t become cancerous.  For kids with autoimmunity, the innate immune system becomes misguided triggering the adaptive immune system to not only attack invaders but to also create antibodies against healthy cells and tissues2. Over time, this inflammatory process causes significant damage reducing quality of life and increasing the risk of other serious health issues3.

Helping kids with autoimmunity thrive means taking a deep dive into root causes—providers need to understand why the immune system assaults the child it’s designed to protect before they can structure the care plan.

Genetics and environmental triggers are well-established factors but may not always lead to autoimmune disease development on their own4. Researchers are now investigating how a faulty gut barrier and gut dysbiosis contribute to autoimmune disease development.

The Gut-Autoimmune Connection

The small intestine houses 70—80% of the body’s immune cells making it an important player in autoimmune disease development and progression5. The single-celled layer of the small intestine (composed of desmosomes, tight junctions, and adherens junctions) is tasked with policing what should stay in the GI tract and what should be absorbed into the systemic circulation with the help of the gatekeeper protein, zonulin 6,7.

 

Source: The intestinal barrier: a fundamental role in health and disease – PMC (nih.gov)

Research suggests that zonulin may be upregulated in kids with autoimmunity making the intestinal barrier more permeable than it should be 7.

A compromised barrier allows toxins, microbes, and large undigested food particles to cross between the cells lining the small intestine (via paracellular transport) and enter the blood stream. When the immune system senses these invaders, it gets to work to resolve the threat by increasing inflammatory mediators. As this assault continues over time innocent cells, tissues, and organs are damaged 6.

Restoring normal gut barrier function may be an important target of therapy for kids with all types of autoimmune conditions. Food plays an integral role in inflammation, immune system function, gut microbial balance, and gut barrier function, so it’s a great first place to start 9,10.

Nutrition in Pediatric Autoimmunity

A dietary pattern high in ultra-processed foods and low in fiber and micronutrients increases inflammation and alters immune system function by disturbing gut microbial balance and increasing intestinal permeability9.  Interestingly, zonulin (the gatekeeper of the intestinal tight junctions) is most often upregulated by microbial dysbiosis or gliadin exposure, both of which are diet-driven7.

On the other hand, a nutrient-rich anti-inflammatory dietary pattern (like the Mediterranean diet) is associated with lower levels of inflammation, gut microbiome balance, and better immune system function10. A small pilot study of kids with juvenile idiopathic arthritis found they had less pain and morning stiffness, better physical function, lower inflammatory markers, and higher fecal butyrate levels after four weeks on an anti-inflammatory diet11.

Outside of a gluten-free diet for kids with celiac disease, there isn’t one specific diet for all autoimmune conditions. IFNCP Functional Nutritionists tailor diet therapy to the specific needs of the child, often as part of a 5-R protocol for gut healing12:

  • Remove what’s damaging the gut lining (common food allergens, ultra-processed foods, non-nutritive sweeteners, excess sugar, food dyes and additives, environmental toxins, pathogens, and unmanaged stress).
  • Replace what’s missing (digestive secretions and nutrients of concern).
  • Reinoculate the gut with beneficial microbes (pre- and probiotics).
  • Repair the gut barrier (l-glutamine, omega-3 fatty acids, and zinc carnosine).
  • Rebalance the lifestyle (stress management, time in nature, healthy amounts of physical activity, and adequate sleep).

Practical Tips for Implementing a Pediatric 5R Protocol

Diet and lifestyle changes can be extremely impactful but challenging to implement in the pediatric population. Kids can be picky eaters, older children and teens are often impacted by peer pressure, and following an anti-inflammatory lifestyle can be less convenient for busy families.

Strategies for overcoming these challenges include:

  • Explaining (in an age-appropriate way) the autoimmune condition and how nutrition and lifestyle impact symptoms.
  • Encouraging family support and positivity about nutrition and lifestyle changes.
  • Detailing each step of the process in plain language.
  • Providing a detailed timeline and encouraging kids and families to maintain a calendar.
  • Encouraging kids and teens to be involved in treatment planning.
  • Providing a range of therapeutic options to choose from when goal setting.
  • Celebrating positive changes.
  • Educating parents to avoid perfectionistic thinking.
  • Maintaining a safe space for communication.
  • Providing easy-to-understand resources.

Healing the gut can be an incredibly powerful way to reverse pediatric autoimmune disease symptoms, possibly reduce the need for strong medications, and improve long-term outcomes. While food is a very important component, it’s not the only root cause of gut dysfunction and autoimmune disease symptoms.

Uncovering Root Causes with STAIN©

Many different system imbalances contribute to pediatric autoimmune disease development and symptoms.  The Integrative and Functional Nutrition Academy STAIN© model offers insight into the root causes of systems imbalances and assists healthcare professionals in structuring their analysis to create more comprehensive, personalized treatment plans.

When working with kids with autoimmunity, it’s crucial to understand what has led to the diagnosis and which therapies will be most effective for symptom reversal. Here’s an example of how an IFNCP Functional Nutritionist may employ STAIN© for a client with pediatric autoimmunity:

  • Stress – higher stress levels contribute to worsening autoimmune-related symptoms in children
  • Toxins – mercury exposure may contribute to autoimmune disease development in children
  • Adverse food reactions – casein consumption may lead to autoimmune disease development in susceptible children
  • Infections—enterovirus and the flu virus may contribute to the development of childhood type 1 diabetes
  • Nutritional factors—malnutrition contributes to altered immune system function and pediatric autoimmune conditions may increase the risk of nutrient depletion17, 18, 19, 20.

Children with Autoimmune Diseases Can Thrive

Nutrition therapy is often a care plan component for children with certain autoimmune conditions, but it may be overlooked in others. An integrative and functional nutrition approach that targets the root causes of autoimmunity may help to improve quality of life, reduce the need for medication, and improve long-term outcomes for all kids no matter the autoimmune condition. To learn more about using food and lifestyle as medicine, sign up for your IFN Academy training today.

By: Kellie Blake, RDN, LD, IFNCP

References:

  1. D’Auria, E., et al. (2023). Allergy and autoimmunity in children: non-mutually exclusive diseases. A narrative review. Frontiers in pediatrics, 11, 1239365. https://doi.org/10.3389/fped.2023.1239365
  2. Pisetsky, D.S. Pathogenesis of autoimmune disease. Nat Rev Nephrol19, 509–524 (2023). https://doi.org/10.1038/s41581-023-00720-1
  3. Autoimmune Diseases. Boston’s Children’s Hospital. Autoimmune Diseases | Boston Children’s Hospital (childrenshospital.org). Accessed July 30, 2024.
  4. Wang, L., Wang, F. S., & Gershwin, M. E. (2015). Human autoimmune diseases: a comprehensive update. Journal of internal medicine, 278(4), 369–395. https://doi.org/10.1111/joim.12395
  5. Vighi, G., Marcucci, F., Sensi, L., Di Cara, G., & Frati, F. (2008). Allergy and the gastrointestinal system. Clinical and experimental immunology, 153 Suppl 1(Suppl 1), 3–6. https://doi.org/10.1111/j.1365-2249.2008.03713.x
  6. Kinashi, Y., & Hase, K. (2021). Partners in Leaky Gut Syndrome: Intestinal Dysbiosis and Autoimmunity. Frontiers in immunology, 12, 673708. https://doi.org/10.3389/fimmu.2021.673708
  7. Fasano A. (2011). Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer. Physiological reviews, 91(1), 151–175. https://doi.org/10.1152/physrev.00003.2008
  8. Vancamelbeke, M., & Vermeire, S. (2017). The intestinal barrier: a fundamental role in health and disease. Expert review of gastroenterology & hepatology, 11(9), 821–834. https://doi.org/10.1080/17474124.2017.1343143
  9. Malesza, I. J., et al (2021). High-Fat, Western-Style Diet, Systemic Inflammation, and Gut Microbiota: A Narrative Review. Cells, 10(11), 3164. https://doi.org/10.3390/cells10113164
  10. Venter, C., Eyerich, S., Sarin, T., & Klatt, K. C. (2020). Nutrition and the Immune System: A Complicated Tango. Nutrients, 12(3), 818. https://doi.org/10.3390/nu12030818
  11. Berntson, L. A pilot study of possible anti-inflammatory effects of the specific carbohydrate diet in children with juvenile idiopathic arthritis. Pediatr Rheumatol19, 88 (2021). https://doi.org/10.1186/s12969-021-00577-3
  12. Institute for Functional Medicine. The 5R Framework for Gut Health. This video introduction to the 5R framework for treating digestive disorders is presented by Vincent Pedre, MD. (ifm.org) Accessed 08-14-2024.
  13. Dimitrijevic Carlsson, A., Wahlund, K., Kindgren, E., Frodlund, M., & Alstergren, P. (2024). Increase in stress contributes to impaired jaw function in juvenile idiopathic arthritis: a two-year prospective study. Pediatric rheumatology online journal, 22(1), 30. https://doi.org/10.1186/s12969-024-00966-4
  14. Heller A, Nolan K, Rametta S. Mercury Induced Autoimmunity: A Case of CASPR2/LGI1 Autoimmune Encephalitis in a 14-Month-old. Child Neurology Open. 2024;11. doi:1177/2329048X241227347
  15. Aristo Vojdani, Lydia R. Gushgari, Elroy Vojdani, Interaction between food antigens and the immune system: Association with autoimmune disorders, Autoimmunity Reviews, Volume 19, Issue 3, 2020, 102459, ISSN 1568-9972, https://doi.org/10.1016/j.autrev.2020.102459.
  16. Smatti, M. K., Cyprian, F. S., Nasrallah, G. K., Al Thani, A. A., Almishal, R. O., & Yassine, H. M. (2019). Viruses and Autoimmunity: A Review on the Potential Interaction and Molecular Mechanisms. Viruses, 11(8), 762. https://doi.org/10.3390/v11080762
  17. Bourke, C. D., Berkley, J. A., & Prendergast, A. J. (2016). Immune Dysfunction as a Cause and Consequence of Malnutrition. Trends in immunology, 37(6), 386–398. https://doi.org/10.1016/j.it.2016.04.003
  18. Fritz, J., Walia, C., Elkadri, A., Pipkorn, R., Dunn, R. K., Sieracki, R., Goday, P. S., & Cabrera, J. M. (2019). A Systematic Review of Micronutrient Deficiencies in Pediatric Inflammatory Bowel Disease. Inflammatory bowel diseases, 25(3), 445–459. https://doi.org/10.1093/ibd/izy271
  19. Kreutz, J. M., Adriaanse, M. P. M., van der Ploeg, E. M. C., & Vreugdenhil, A. C. E. (2020). Narrative Review: Nutrient Deficiencies in Adults and Children with Treated and Untreated Celiac Disease. Nutrients, 12(2), 500. https://doi.org/10.3390/nu12020500
  20. Grammatikopoulou MG, Gkiouras K, Syrmou V, Vassilakou T, Simopoulou T, Katsiari CG, Goulis DG, Bogdanos DP. Nutritional Aspects of Juvenile Idiopathic Arthritis: An A to Z for Dietitians. Children. 2023; 10(2):203. https://doi.org/10.3390/children10020203