A Deeper Dive into AID

A Lifestyle-Based, Functional Health Approach for Autoimmune Disease

What is autoimmunity?

One of the functions of the immune system is to protect the body by responding to invading microorganisms, such as viruses or bacteria, by producing antibodies or sensitized lymphocytes (types of white blood cells). Under normal conditions, an immune response cannot be triggered against the cells of one’s own body. In certain cases, however, immune cells make a mistake and attack the very cells that they are meant to protect. This can lead to a variety of autoimmune diseases. They encompass a broad category of related diseases in which the person’s immune system attacks his or her own tissue.¹

There are 80-100 known autoimmune diseases, and many more conditions are autoimmune-related or include suspected autoimmune components. Many autoimmune diseases overlap, or exhibit comorbidities and coexisting symptoms. If you have three or more autoimmune diseases, this is known as Multiple Autoimmune Syndrome (MAS).²

Some autoimmune diseases are organ-specific as they affect certain areas of the body, such as the joints, gastrointestinal tract, skin, or as in type 1 diabetes, the insulin-producing cells of the pancreas. Others are systemic, meaning that immune attack occurs in different tissues of the body. Examples of systemic autoimmune diseases are Sjögren’s syndrome, systemic lupus erythematosus, scleroderma, and rheumatoid arthritis.²

According to the National Institutes of Health (NIH) autoimmune diseases affect more than 24 million people in the United States.³ However, some feel these numbers are too low.  The American Autoimmune Related Diseases Association (AARDA) states:

• 50 million Americans have one or more autoimmune diseases.
• Approximately 75 percent of those affected are women.
• Autoimmune diseases are among the top 10 leading causes of death among American women.
• Autoimmune diseases tend to cluster in families, impacting multiple family members and generations.⁴

Increasing prevalence of Autoimmune and Inflammatory Disorders

A 2020 study used antinuclear antibodies (ANAs), the most common biomarkers of autoimmunity, to show an alarming, 50% overall rise in autoimmunity in just 25 years.  Growing evidence suggests that autoantibodies (immune system proteins that mistakenly target the body’s own tissues) precede the onset of symptomatic autoimmune disease by many years. Thus, ANA may be an intermediate marker on the pathway to disease or may signal increased susceptibility to autoimmune diseases through related causal pathways. Weight, smoking history and alcohol consumption had little impact on the increase in the prevalence of antinuclear antibodies, suggesting that other changes in lifestyle or the environment might be driving the rise in autoimmunity. ^5,6

The Roots of Autoimmune

What causes autoimmunity?

The immune system normally can distinguish “self” from “non-self.” Some lymphocytes are capable of reacting against self, resulting in an autoimmune reaction. Ordinarily these lymphocytes are suppressed. Autoimmunity occurs naturally in everyone to some degree; and in most people, it does not result in diseases. Autoimmune diseases occur when there is some interruption of the usual control process, allowing lymphocytes to avoid suppression, or when there is an alteration in some body tissue so that it is no longer recognized as “self” and is thus attacked.¹

The exact mechanisms causing these changes are not completely understood; but bacteria, viruses, toxins, and some drugs may play a role in triggering an autoimmune process in someone who already has a genetic (inherited) predisposition to develop such a disorder. It is theorized that the inflammation initiated by these toxic or infectious agents somehow provokes in the body a “sensitization” (autoimmune reaction) in the involved tissues.

The most challenging aspect of autoimmunity is to identify the early events that trigger immune dysregulation and autoimmunity. In recent years, increasing attention has been paid to define the contribution of environmental agents in the pathogenesis of ADs. The environmental factors account for up to 70% of all ADs. Strong evidence exists linking environmental agents, including solvents, crystalline silica, mercury, pesticides, pristine, and cigarette smoking with the development of various ADs.^7-11

Apart from genetic makeup and exposure to environmental triggers, inappropriate increase in intestinal permeability (which may be influenced by the composition of the gut microbiota), a “hyper-belligerent” immune system responsible for the tolerance–immune response balance, and the composition of gut microbiome and its epigenetic influence on the host genomic expression have been identified as three additional elements in causing chronic inflammatory disorders.¹²

An inappropriate increase in intestinal permeability (“leaky gut”) and altered composition of gut microbiota (dysbiosis), have been implicated in a number of autoimmune diseases including, but not limited to:

• Systemic lupus erythematosus (SLE)^13,14
• Rheumatoid arthritis (RA)^15,16
• Multiple sclerosis (MS)^17-19
• Hashimoto’s disease^20,21

Increased permeability of other barrier structures including the gum,²² lung,²³ and blood-brain²⁴ barriers have also been implicated in autoimmune disease.

The Exposome in Autoimmune Diseases

While a significant focus has been placed on the influence on diseases of gene factors or the genome, it has been suggested that more attention needs to be paid to the role of environmental factors in autoimmune disorders. Our genome provides the blueprints, but it is our environment that determines what we become. Dr. Elroy Vojdani coined the term “exposome” to refer to one’s lifetime exposure to a variety of external and internal sources which includes food/diet, toxic chemicals, infectious pathogens, and lifestyle.^25,26  The exposome is considered to be the environmental equivalent of the genome and is defined as to the systematic and comprehensive analysis of nongenetic factors influencing our health, which is essential for understanding the basis of complex disease.

Similarly, the infectome has been defined as the part of the exposome referring to the collection of an individual’s exposures to infectious agents. Infectious triggers implicated in autoimmunity are also numerous and include bacteria, viruses, parasites and fungi.^26,27

Recent observations indicate a particular importance of mold/mycotoxin exposure in individuals with pre-existing dysregulation of the immune system, due to exacerbation of underlying pathophysiology including inflammatory diseases and autoimmune disorders. Specific autoimmune diseases that have shown an association with mold/mycotoxin exposure include MS, RA and autoimmune hypothyroidism.^28-31

Viruses have been considered as major environmental factors that trigger the autoimmune phenomena in genetically susceptible individuals.³² Systemic lupus erythematosus, multiple sclerosis, rheumatoid arthritis and Hashimoto’s thyroiditis are three of the best studied diseases so far for which specific viral agents have been considered to be important for the development of the disease and the breakdown of immunological tolerance.^33,34

SARS-COV-2 and Autoimmunity

The COVID-19 pandemic put the spotlight on SARS-CoV-2, which has been called “the autoimmune virus.”²⁶ Although the exact pathogenetic mechanism is still unknown, studies have  indicated that SARS-CoV-2 infection stimulates the production of multiple autoantibodies which in turn may result in life-threatening autoimmune diseases. It seems that the immune response may not be well regulated in some infected individuals, paving the way for the development of secondary autoimmunity to SARS-CoV-2.^35-39

In addition, it has been theorized that long COVID could be an autoimmune disease.  To illustrate this possibility, studies have noted shared symptoms between long COVID and suspected ADs like chronic fatigue syndrome (ME/CFS) and fibromyalgia-  including persistent fatigue, widespread muscle pain, memory difficulties, and mood disorders.^40-43

Women and Autoimmunity

Women have a higher incidence and prevalence of autoimmune diseases than men, and 85% or more patients of multiple autoimmune diseases are female. Why?  Research has suggested that this is because women undergo sweeping endocrinological changes multiple times during their lifetime.  Puberty and menopause are the two most common, with many women undergoing the additional transitions of pregnancy, possibly being accompanied by breastfeeding. These endocrinological transitions exert significant effects on the immune system due to interactions between the hormonal milieu, innate, and adaptive immune systems as well as pro- and anti-inflammatory cytokines, and thereby amplify the susceptibility of women to autoimmune diseases. In addition, genetics, gender-specific gut microbiome profile and an evolutionary bias have been suggested as plausible explanations for females being 2–10 times more susceptible than males into a wide range of autoimmune disorders, including rheumatoid arthritis (RA), Multiple Sclerosis (MS), systemic lupus erythematosus (SLE), and Hashimoto’s thyroiditis.^44-49

Functional and Conventional Approaches

Conventional Medical Approach: Diagnosing Autoimmune Disease

For people with autoimmune diseases, getting a proper diagnosis can be one of the most difficult challenges they face. The average autoimmune patient sees four doctors over the course of four years to get a proper diagnosis.⁵⁰

AARDA conducted a survey of autoimmune disease patients and found that the majority of those eventually diagnosed with serious autoimmune diseases had significant problems in getting a correct diagnosis. Many were incorrectly diagnosed with a variety of conditions that have no specific blood test to confirm the diagnosis. Many were told that their symptoms were “in their heads” or that they were under too much stress. Furthermore, the survey revealed that 45 percent of autoimmune disease patients had been labeled as chronic complainers or were told that they were overly concerned with their health in the earliest stages of their illnesses.⁵²

In a preliminary study of 130 family physicians in fall 2013⁵³, AARDA found:

• 64 percent of family physicians stated they are “uncomfortable” or “stressed” when diagnosing autoimmune disease in patients.
• 73 percent do not believe they received adequate training in diagnosing and treating autoimmune diseases.
• 57 percent reported they had only one or two lectures on autoimmune disease in medical school.

Treating Autoimmune Disease

There is no “autoimmunologist” medical specialty. Autoimmune disease symptoms are often treated with an organ-specialty approach. Medical specialists typically familiar with autoimmune disease (AD), and the specific ADs they often diagnose and treat, include:⁵³

• Dermatologists
• Endocrinologists
• Gastroenterologists
• Immunologists
• Internists
• Neurologists

Medications and biologic drugs are used in the management of autoimmune diseases in an attempt to: control disease flares, limit inflammatory damage, and extend periods of remission. However, consistent results may not be seen in each patient, there may be potentially serious side effects, and higher financial costs have also been noted. A 2012 report showed that the effectiveness of approved therapeutics (medications) in a broad group of autoimmune diseases was no more than 50%.

In the case of biologic therapies the expectation is for even poorer treatment effectiveness.  Forecasting predicts a likely failure to achieve remission in more than 20-30% of patients. Echoing this potential outcome, a 2017 report on anti-TNF biologics reported that up to 40% of patients have no response to anti-TNF treatment.  Anti-TNFs are a class of biologics that inhibit inflammation by blocking a small pro-inflammatory protein.

Although biologics have proven to be an effective treatment for some patients with RA or other diseases, like psoriasis, they are recommended only for patients with insufficient response or intolerance to Disease-modifying Antirheumatic Drugs (DMARDs) because of their cost.^54-59  DMARDs are commonly used in people with rheumatoid arthritis. Some of these drugs are also used in treating other conditions such as ankylosing spondylitis, psoriatic arthritis, and systemic lupus erythematosus.

Remission is a possibility in AD, but current treatment strategies are not able to achieve this. We have well-established protocols for infections, oncology, metabolic diseases, and transplantation which are often used as models for the management of AD. Studies and observations suggest that in contrast to diseases used as a role model, AD, a highly dynamic and individualized condition by nature, has wide variability, along with different causative and pathogenic processes.  AD’s nuanced complexity versus the treatment model’s simplicity makes the current treatment strategies fall short of complete remission.⁶⁰

A Functional Healthcare Approach for Autoimmune Disease

Functional Healthcare offers an alternative to symptom suppression—by addressing the underlying mechanisms that cause autoimmunity, we can prevent, and in some cases reverse, autoimmune diseases.

Rather than focusing on a single cause, a functional health approach to autoimmune disease takes into account the multiple contributors. Considered in the broadest sense, targets for this therapeutic lifestyle approach include the following major modifiable factors:

• Food intake and nutritional status;
• Digestive system dysfunction, infection and imbalanced gut bacteria;
• Imbalance in immune cells that promote versus dampen inflammation;
• Dysfunctional mitochondria, the “power plants” in every cell responsible for manufacturing ATP (the body’s energy compound);
• Psycho-emotional and physical stressors;
• Hormonal imbalances; and
• Exposure to and accumulation of toxins and dysfunction in the body’s detoxification system.