Intolerance to Self
Autoimmune hypothyroid (Hashimoto’s thyroiditis), type 1 diabetes, multiple sclerosis, Crohn’s, celiac, lupus, psoriasis. These constitute a sampling of the over 100 identified autoimmune diseases. It is estimated by the NIH that between 3-5% of the population suffers from an autoimmune condition (and between 23.5-50 million Americans). They can be debilitating, confusing, heart-breaking, deadly, and frustrating.
What is Autoimmunity?
The standard line when defining autoimmunity is that the body’s immune system becomes “confused” and begins to attack and destroy various self-tissues. Basically, an immunological intolerance to self. It is not uncommon for someone to suffer from more than one autoimmune condition at a time, or for several types of autoimmune conditions to show up in a single family line (e.g. grandmother, mother, daughter). Susceptibility to autoimmunity often has a genetic component, but what activates those genes is almost always environmental, which means you are not at the mercy of your genes. Autoimmune conditions affect women more often than men, the AARDA (aarda.org) states that autoimmune diseases are in the top 10 leading causes for death in females from birth to age 64. This means that autoimmunity is often a women’s health issue.
A Background on the Human Immune System
The immune system is divided into two subcategories: the innate and adaptive. The innate system is what we are born with as a natural shield (both physical and chemical) to foreign materials. This includes our skin, digestive and respiratory tract lining, saliva, tears, and stomach acid. The effects of the innate immune system are non-specific but usually include an inflammation and debris-clearing response. The response of the innate immune system is the same regardless of the invader and there is no memory generated. If the innate immune system cannot keep an invading pathogen (disease agent) out of the body, it works with the adaptive immune system for targeted pathogen removal/destruction. The adaptive immune system is more specific in what it chooses to react to and can decrease the body’s reaction to specific invaders over time. Once activated the adaptive immune system sets to work creating antibodies and recruiting cells and chemicals that will work to neutralize a pathogen or pathogen-infected cell. At the same time the adaptive immune system is creating cells that store the memory of the specific invader so that if it is encountered in the future, the immune system kicks into action much more efficiently. These adaptive cells must be taught by the body what is self and what is non-self. When cells get this right and can distinguish between the two it is called tolerance. If the body does not complete its job in teaching these cells to be tolerant, the confused cells can become problematic, mounting an immune response to self-tissues, resulting in autoimmunity.
Environmental Triggers for Autoimmunity
The following are the external factors that exert pressure on the immune system:
- Microorganisms: infections of bacteria (e.g. Strep), viruses (e.g. Epstein-Barr), parasites, and/or fungi.
- Xenobiotics: tobacco, UV light, pharmaceutical drugs, heavy metals.
- Microbiota: the composition of bacterial communities living in your gut.
- Nutrition: various nutrients such as vitamin D, iodine, and food additives.
Not mentioned above is the importance of maintaining balance within the body’s own systems. Hormone imbalances can lead to dysfunctional innate and adaptive immune responses, especially in women who experience normal cyclic fluctuations in their hormones. Nervous system imbalances can also lead to dysfunction, cortisol (the stress hormone) and epinephrine (adrenaline) contribute to a suppressed immune response which can decrease our ability to fight off microorganism infection and lead to faulty self vs. non-self recognition.
Assessing autoimmunity includes a comprehensive list of testing, mostly through bloodwork, to determine if there are specific products of autoimmunity present in the body. These include antimitochondrial antibodies (AMA), rheumatoid factor (RF), and antithyroperoxidase antibodies (TPO). More extensive testing can include tissue biopsy, x-rays, MRI, hormone and genetic testing. All of the testing gives a clue to what kind of autoimmune condition is occurring in the body and allows doctors to diagnose the disease. A diagnosis will guide the treatment options and approaches considered by medical practitioners.
Treatment Approaches: Conventional Medical Practitioners
Most patients of an autoimmune condition will see a rheumatologist to guide them through their treatment decision-making. Rheumatism is defined as, “any of various conditions characterized by inflammation or pain in muscles, joints, or fibrous tissue.” Currently, most autoimmune condition treatments start at a rheumatologist’s office who specializes in immune-modulated inflammatory diseases. The most common drugs include anti-inflammatory steroids, immune suppressants, and biologics. Biologics target pieces of the immune inflammatory cascade to stop inflammation and tissue destruction. The side effects of these drugs include infections, cancer, nausea, vomiting, and anemia. While that list is quite scary to read, some patients require the drugs just to get to a stable place where they can begin digging deeper to find the root of the problem.
Treatment Approaches: Naturopathic, Functional, and Integrative Practitioners
Naturopathic doctors are trained to look at the body as a whole instead of breaking it into unrelated pieces. The research shows that the immune system is not relegated to one small section of the body. Instead it reaches into every other system and interacts in a bi-directional way. A naturopathic doctor will assess and address a patient’s exposure to factors that can increase autoimmune susceptibility. These factors include: nutritional status, infections history, gut dysbiosis, metabolic dysfunction, stress and sleep status, endocrine (hormone) imbalances, and xenobiotic exposure. With this list a potential source or sources of autoimmune trigger(s) can be identified; and through lifestyle, nutrition, and targeted therapies, the root cause of the autoimmunity can be addressed.
The work of a naturopathic doctor includes finding out what is causing inflammation. If there is dysbiosis in the gut, a protocol for restoring normal gut flora and healing the intestinal lining is in order. If the inflammation is coming from exposure to xenoestrogens in plastics, then the solution is to get rid of plastics in the daily routine, followed by clearing the hormones through diet, herbs, and regular bowel movements. If a patient is low in vitamin D, a nutritional supplement might be prescribed. If hostile relations between loved ones is at the root of the inflammation, then counseling and effective communication techniques are recommended. Is lack of sleep an issue? Then getting to the bottom of crummy sleep is certainly a priority. Too stressed to cope? There are research papers that study the inflammation-lowering effects of joy and gratitude. Is lack of exercise the culprit? Moderate exercise is showing a lot of potential for lowering inflammation, benefitting sleep, and soothing stress. Simply taking a pill and suffering the side effects is not on the naturopathic menu. With guidance from a naturopathic doctor each patient can more easily access the medicine within themselves.
This article is for educational purposes only and does not intend to diagnose or treat any diseases or conditions.
Dr. Sarah Buck is a naturopathic doctor working in Yarmouth, Maine. She was drawn to naturopathic medicine because of the ability to blend the science and art of medicine. Each patient requires a blend of select therapies, and Dr. Buck uses combinations of botanical medicine, nutritional medicine, pharmaceutical medicine, naturopathic hydrotherapy, counseling, and homeopathy to treat her patients. Gastrointestinal health, sleep, and autoimmune health are a few of her areas of interest.
You can find her on Instagram and Facebook @SarahBuckND. (p): 207.200.6597.