Autoimmune diseases have become increasingly more common. Medical doctors are taught that our health is the result of our genes and that health is preprogrammed and predetermined. This view rejects the possibility that health reflects an accumulation of choices that we make and the environmental impact around us. The reality is our health and well-being are the result of how our environment interacts with our genes.
There are different autoimmune diseases within all specialties and all of these are looked at individually yet they all share common triggers. Therefore in knowing what causes the immune system to attack itself and knowing some of the triggers for what causes a malfunction in the immune system (which we do) we can achieve greater success in helping patients with these conditions.
Autoimmunity occurs a few different ways. With Hashimoto's or Graves disease the immune system attacks the thyroid. With lupus the immune system attacks the skin, the joints and kidneys and various blood cells. Yet what causes the immune system in one person to attack the thyroid and in another to attack the skin is not well understood, but what we do know is that there are common triggers that appear to initiate or predispose the immune system to malfunction.
These triggers include stress, infections, environmental toxins, food sensitivities, nutritional deficiencies, and a compromised intestinal barrier (commonly called leaky gut). Once we understand this we can see that the approach to the patient with lupus should be not fundamentally different than the patient with thyroid disease or any other autoimmune condition.
The common triggers for autoimmunity are:
- Stress: Stress causes an imbalance in the Th1/Th2 cytokine balance. The Th1 response is associated with cell-mediated immunity while the Th2 response is associated with humoral immunity. When Th1 is too high relative to Th2 the immune system launches autoimmune attacks on the body; when Th2 is too high relative to Th1 we see allergies and increased susceptibility to infections.
- Infections: Both acute and chronic infections including viral, bacterial and fungal infections have been implicated in initiating or exacerbating autoimmune disease. The mechanism is called molecular mimicry—the infection the immune system mounts against the invading pathogen is so similar to structures on the body's own tissues that the immune system attacks itself.
- Environmental toxins: Mercury and other heavy metals, pesticides, and other environmental toxins, have been implicated in triggering autoimmune diseases. Mercury in particular has been implicated in triggering lupus and other autoimmune conditions. There is a known correlation between mercury toxicity and antinuclear antibodies (ANA), which is elevated in many autoimmune conditions.
- Food sensitivities: Food sensitivities (in particular to gluten and other grains) have been implicated as triggers for autoimmune disease. The mechanism involves antibody production against food antigens that cross-react with self-tissues. There is also well documented relationship between gluten sensitivity and celiac disease and various autoimmune conditions. Gluten sensitivity has been implicated in thyroid disease, neurological autoimmunity, and various other autoimmune conditions.
- Nutritional deficiencies: Vitamin D deficiency has been implicated in the development of autoimmune disease. Patients with autoimmune diseases have been shown to have low vitamin D levels compared to controls. Studies have shown that vitamin D deficiency is a risk factor for the development of autoimmune disease. Omega-3 fatty acids, which are inherently anti-inflammatory, have also been shown to be beneficial in autoimmune disease.
- Intestinal barrier dysfunction ("leaky gut"): Zonula occludens-1 (ZO-1) is a protein that maintains the tight junctions of the intestinal epithelium and controls intestinal permeability. When intestinal permeability is increased (leaky gut) bacterial lipopolysaccharides (LPS) are absorbed which activate toll-like receptors on the immune system and trigger an immune response. Some would propose that increased intestinal permeability is the primary initiating event in the development of autoimmune disease.
Thus the treatment approach to autoimmune disease is to identify and correct the triggers for autoimmunity. This approach is much more effective than merely trying to suppress the immune system which is the conventional approach. The conventional approach suppresses the immune system and results in increased susceptibility to infections and in some cases an increased risk of cancer.
Steps in the treatment of autoimmune disease include:
- Identifying and eliminating food sensitivities—Often a trial of a gluten free diet is a good place to start
- Reducing stress
- Identifying and treating infections
- Avoiding environmental toxins
- Supporting nutritional status and correcting deficiencies—especially vitamin D and omega-3 fatty acids.
- Supporting and repairing the intestinal barrier—with the use of L-glutamine, bone broth, zinc carnosine, and other natural supplements that promote intestinal healing.