What is loss of oral tolerance?


If you have an autoimmune condition, you may be familiar with restricted diets such as the autoimmune protocol (AIP), GAPs, or FODMAPs. These diets can significantly reduce inflammation, help you determine food sensitivities, and address root causes of mysterious symptoms. However, some people experience little to no improvement and may even get new food sensitivities. The culprit could be loss of oral tolerance.

The good news is you can start improving your oral tolerance now so you react to fewer foods.

There are different types of tolerance:

  • Chemical tolerance is the ability to appropriately tolerate chemicals in the environment without an immune reaction, such as reacting to perfumes.
  • Self-tolerance is your immune system’s ability to recognize and respond appropriately to your own body. Loss of self-tolerance leads to autoimmune disease.
  • Oral tolerance is the immune system’s ability to properly recognize and tolerate food proteins.

Any of these forms of tolerance can be lost when the immune system is out of balance. When you lose one you are more likely to lose the others since they are based on similar underlying factors.

If you experience increased food sensitivities, you may be losing oral tolerance.

Over reactive dendritic cells and oral tolerance

Dendritic cells are immune cells in the small intestine that determine whether the immune system should react to foods.

They become over reactive when food proteins aren’t thoroughly digested, which can lead to loss of oral tolerance. You can support digestion by taking hydrochloric acid (HCL) and digestive enzymes with your meals.

Another cause for over reactive dendritic cells is low levels of SIgA cells, antibodies that defend the gut.

Retinol vitamin A (not beta carotene) at 5000 IU a day can help support oral tolerance. However, the main approach to boosting SIgA cells is to address adrenal fatigue, chronic infection, steroid use, or other chronic stressors to your immune system.

Regulatory T cells and oral tolerance

Regulatory T cells (T reg cells) decide whether the immune system should accept food proteins or attack them, causing an inflammatory response. You can encourage your T reg cells to dampen inflammation through plentiful omega 3 fatty acids, supplemental forms of absorbable glutathione, and vitamin D.

Boosting endorphins, our own feel-good chemicals that we get from exercise, laughter, and other pleasurable activities, also dampens inflammation and modulates immune function.

Liver detox

Managing liver detox function can help improve oral tolerance. The liver has two key detox pathways that make fat-soluble compounds water-soluble for the body to eliminate:

Phase I pathway changes a compound’s structure so molecules can attach to it in the next step.

Phase II pathway involves multiple steps that help attach molecules to the compound so it can be eliminated safely.

Ask my office about nutritional and botanical compounds that support liver detoxification and bile synthesis and elimination.

When starting liver detox supplements, choose a quality brand that combines many nutrients, and start slowly to avoid unpleasant side effects.

Diversity of gut bacteria

A rich diversity of gut flora is one of the most important things for healthy oral tolerance. These bacteria produce short chain fatty acids (SCFA), which help dampen inflammation.

For some people, a limited diet can reduce the variety of gut bacteria. Eat a wide variety of produce and try to consume at least 7 to 9 servings of fruits and vegetables a day to support oral tolerance. Be cautious of inflammatory blood sugar spikes from too much fruit.

In addition to eating varied and plentiful produce, you can supplement with SCFA.

Other factors that affect oral tolerance

Other factors that affect oral tolerance include histamine reactions, eating too much salt (excess sodium is inflammatory), hormonal imbalances, hypothyroidism, and more.

Chronic stress can also impact oral tolerance by producing high levels of adrenal hormones that suppress SIgA cells and also lead to depression, insulin resistance and diabetes, high blood pressure, and more.

Chronic stress can take many forms, such as:

  • Food intolerances
  • Autoimmunity
  • Systemic inflammation
  • Emotional conflict and worry
  • Exposure to environmental toxins
  • Blood sugar imbalances
  • Chronic pain
  • A diet high in sugar and starches

Blood sugar imbalances are one of the most common causes of chronic stress. When your blood sugar spikes high or low, the stress response suppresses SIgA cells and promotes leaky gut and inflammation, leading to loss of oral tolerance. Blood sugar imbalances are at the root of hormonal imbalances and many other metabolic disorders.

Mediate blood sugar imbalances with anti-inflammatory diet low in sugars and carbs, plenty of exercise, and stress management techniques.

Lab testing for oral tolerance

A food sensitivity panel can determine which foods need to be avoided, and can also show how well your oral tolerance protocol is working.

However, if you have clear symptoms of oral tolerance but your panel shows few to no positive markers, you may have a depressed immune system. In this case, it’s important to first boost SIgA levels.

You can screen for low SIgA prior to your Cyrex test by ordering a total immunoglobulin (IgG, IgA, and IgM) test.

If you are experiencing symptoms of food reactivity and loss of oral tolerance, contact my office for more advice.

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