By Terry Willard ClH,PhD
This is the third blog in this series. The first one looked at a few mini case studies and a possible framework to look at. The second related to more of the causes. In this blog we will start to look at resources to result autoimmune issues.
Still other environmental factors could be at play: Smoking is shown to potentially trigger rheumatoid arthritis, lupus, multiple sclerosis, and more (though some studies have been inconclusive). It is known that even meteorological components, such as ultraviolet radiation, temperature, solar flares and humidity, could be triggering autoimmunity.
It wasn’t until Miller’s ground breaking study, published in 2020 in the journal Arthritis & Rheumatology, that strong evidence emerged that autoimmune conditions may indeed be on the rise.
His team analyzed the blood samples of 14,211 people ages 12 to 90 taken over a span of more than two decades, looking for the prevalence of antinuclear antibodies (ANA), the most common biomarker of autoimmune disease. “ANA do not tell you if you have an autoimmune disease, though in many cases they can be the first sign of some immune irregularity that could later lead to one,” Miller explains. ANA can be present for many years before any symptoms start, and some people with ANA may never develop an autoimmune disease.
Still, the results of Miller’s research were startling: about 11% of all people tested between 1988 and 1991 had ANA in their blood, indicating that about 22 million people were affected. That percentage steadily increased through the decades, until 2011 to 2012, when it reached nearly 16%. This corresponded to about 41 million people, which is a near doubling of possibly affected individuals.
There are numerous medications available, which may or may not be an optimal solution, because, for example, “steroids, for better or worse, tend to be the go-to therapies for many of these diseases,” says Mary K. Crow, M.D., a professor of medicine and a senior scientist at the Hospital for Special Surgery and Weill Cornell Medical College in New York City. “Even when patients are treated with biologics, many are also on steroids, but steroids have terrible toxicities, including an increased risk of diabetes and infection. The treatment can sometimes be worse than the disease.”
Immunosuppressants also come with their own risks: they are designed to lower the body’s defenses, and that can result in dangerous consequences. Indeed, often it is the battery of drugs being taking to treat RA that sets the stage for death.
Diet: Fancy a burger, a pizza, or maybe some fried chicken? Fast foods like these have become very popular around the world but eating them too regularly could be at least partially responsible for the global spike in cases of autoimmune diseases, scientists say.
A major culprit for autoimmune diseases is Western fast foods, which have gained in popularity and spread around the globe, according to Lee and fellow researcher Carola Vinuesa.[1]
Fast food diets lack certain important ingredients, such as fibre, and evidence suggests this alteration affects a person’s microbiome—the collection of microorganisms that we have in our gut, and which play a key role in controlling various bodily functions.
Stress: A 2018 study found that people with previously diagnosed stress-related disorders are far more susceptible to autoimmune diseases than those without.[2] What the researchers found was threefold:
- the stressed-out individuals were more likely to be diagnosed with an autoimmune disease,
- more likely to develop multiple autoimmune diseases,
- tended to develop autoimmune diseases earlier in life.
People with PTSD who were being treated with an SSRI antidepressant had lower chances of developing an autoimmune disease.
It is important to note perceived stress is just as significant and ‘real encountered’ stress. There is good evidence that dream time can contribute to stress or alleviate it. If a person gets lots of night terrors, it shows not only a build-up of stress but can also contribute to overall stress load as much as encountered stress. This is one of the reasons to erase built-up stress though forest walking (Shinrin-yoku, which translates to “forest bathing”), time in nature, ‘playing,’ journaling, exercising or even some forms of recreational drug such as cannabis or low-dose psychedelics. Most of our ancestors had festival luminas as almost cleansing times for each season. Think of Mardi gras, le festival, Sun dance, Druid ritual times or even Burning Man. These spectacular displays of pageantry, taking a person right out of their ‘normal’ for a short period of time; and then returning to their normal life thereafter. This seems to clear the decks and reduce the stress levels, often by changing one’s circumstance at least temporarily—kind of like a dream world.
Flare-ups of autoimmune disease come and go throughout life, often triggered by stress, says Michelle Dossett, M.D., an integrative medicine specialist at UC Davis Health in Sacramento, California. “High or chronic stress creates wear and tear on the body that exacerbates inflammation and worsens chronic disease,” she adds. She regularly prescribes the following techniques to help prolong disease remission and improve quality of life:
Meditation: Apps such as Headspace, Calm and Insight Timer teach easy-to-follow meditations of varying lengths.
Yoga or stretching: If you’re limited in your mobility because of your disease, try chair yoga.
Tai chi: One review found that this practice improved quality of life for multiple sclerosis patients.
Controlled-breathing techniques: Try the Breathwork or iBreathe app for breathing exercises. Simple mindfulness exercises may also help with stress management and pain control.
Physical activity: A study of women with lupus showed that muscle strength and cardiorespiratory fitness were both associated with improved quality of life.
The thing is, none of these single issues listed above is the cause of autoimmune disease—the answer is “D”: a combination of the above. Autoimmune issues are conflicts between the inner (psychological world) and the outer (more physical world). The lack of coherence on these two levels creates a dis-harmony between the two realms. The immune system is an interface between these two worlds. If it gets confused, the interface starts to attack itself.
Beware of Big Business
Now this increase in autoimmune disease has become a global market so expect to see and hear more about this—for example in the USA, in 2020 money spent out of pocket was $3.38 billion, and then increased to $4.15 billion in 2021 at a compound annual growth rate (CAGR) of 22.8%. This growth rate is very significant to investors.
The growth is mainly due to the companies resuming their operations and adapting to the ‘new normal’ while recovering from the COVID-19 impact, which had earlier led to restrictive containment measures involving social distancing, remote working, and the closure of commercial activities that resulted in operational challenges.
The market is expected to reach $5.75 billion in 2025 at a CAGR of 8%.
This kind of profit has even made the ‘Big Boys’ pay attention so they will want to herd as many people as possible to their autoimmune solution. You can already find reports on the per patient income stream generated by each patient in growth market reports. So, investors are moving in to these markets, along with all their hype. It might seem strange, but some are even getting autoimmune conditions due to the amount of marketing seen on these conditions.
There is a continual targeting of the elderly for racking up expenses of purchases for health conditions. Autoimmune diseases—a diverse class of afflictions caused by an errant immune system—are scary, often debilitating, and sometimes deadly. And for reasons that researchers don’t fully understand, cases seem to be rising precipitously, especially among people aged 50-plus.
“I’ve been trying to unravel the mysteries of autoimmunity for four decades,” says Frederick Miller, M.D., scientist emeritus with the Environmental Autoimmunity Group at the National Institutes of Health. “Autoimmune conditions, like most diseases, are diseases of age.” If they’re increasing, as his research suggests, over the next 50 years, autoimmune diseases as a group will be some of the most common and costly diseases in society, he notes.
We can find several models for treating Autoimmune issue in other traditions:
In Ayurvedic medicine, most treatable disease arises from the presence of ama, a toxic by-product of poor digestion. One of the features of ama is that once it enters the dhatu cycle it impairs the nutrition and function of the dhatus. To explain the seven dhatus are the seven tissues of the body. Dis-harmony in these tissues can effect the immune system. In English they are plasma, blood, muscle, fat, bone, marrow / nerve, and reproductive tissue. In Sanskrit, they are rasa, rakta, mamsa, medas, asthi, majja, and shukra respectively. These are the structures that make up the body.
Ama has a particular affinity for tissues that are weak and thus accumulates in these locations. Once it is firmly wedged in these locations, the doshas become vitiated, first kapha, with an increase in congestion, followed by pitta which sets up a cycle of inflammation, and then vata, which is responsible for degenerative changes.
You can find similar model in other traditions also.
The modern theory of Intestinal Permeability is that some agent or combination of agents initiates an inflammatory response in the digestive tract. Remember that 70% of the immune system reside in the GIT. Persistent GI inflammation eventually disrupts the integrity of the mucosal lining of the gut, and tiny perforations allow for molecules larger than usual to pass across this barrier, including molecules from dietary protein and fats, bacteria, parasites, and fungi. Candida (yeast) is thought to be the most common cause of this condition. In response to this infiltration, an immune response is initiated, and the body begins to manufacture specific antibodies to these molecules, which the body sees as antigens. Unfortunately, human tissues have antigenic sites, which are almost identical to those substances that pass across a permeable intestinal wall. These antibodies then circulate throughout the body and “look” for more antigens (or antigenic sites). When an antigen is found, such as a tissue that has similar markers to an exogenous antigen, the antibody initiates an immune response, and the body tissue begins to be destroyed.
Factors that directly or indirectly promote gut irritation and inflammation include antibiotics, alcohol, caffeine, parasites, pathogenic bacteria, peroxidized fats, some food preservatives and food additives, enzyme deficiencies (e.g. celiac disease, lactose intolerance), NSAIDs, corticosteroids, refined carbohydrates, oral contraceptives, and mycotoxins (from stored grains and dried fruit).
Chronic gut inflammation damages the protective coating of IgA, the antibody that functions to maintain the integrity of mucous membranes. As a result, the inhibition of a localized immune response allows for a decline of non-specific resistance and an increased risk of viral, bacterial, fungal, and parasitic infection. The toxins that are produced by these microorganisms can inhibit liver function and promote a heightened sensitivity to antigenic triggers such as cigarette smoke and strong perfumes. Thus, many environmental sensitivities, such as hayfever, could be caused, in part, by intestinal permeability or other immune response like dairy sensitivity.
Chronic gut inflammation also damages the absorptive capacity of the epithelium, and thus plays an important role in nutrient deficiency. Antibody-mediated destruction of transport proteins will also inhibit the absorption of these nutrients. Thus, conditions such as osteoporosis and fibromyalgia—which often display a deficiency of certain minerals such as zinc, calcium, and magnesium—can be reasonably linked with increased intestinal permeability. Beyond the impaired absorption of minerals, deficiencies of vitamins, amino acids, and essential fatty acids can lead to the development of many conditions, and such generalized complaints such as fatigue, irritability, poor concentration, and headaches.
Achlorhydria (absence of stomach acid) and hypochlorhydria (deficiency of stomach acid) are increasingly recognized as a factor in leaky gut syndrome and autoimmune disorders, as well as many nutrient deficiencies such as Vitamin B12.
As we age, the parietal cells that secrete hydrochloric acid (HCl) begin to atrophy, and the levels of HCl drop. HCl is necessary for the activation of an enzyme called intrinsic factor, which then assists in the absorption of vitamin B12, or extrinsic factor, necessary for proper nervous function and the formation of red blood cells. Other common nutrient deficiencies in hypochlorhydria or achlorhydria include protein deficiencies as well as mineral deficiencies such as chromium, copper, iron, magnesium, manganese, molybdenum, selenium, and zinc. Aside from aging, causes of low stomach acid include hereditary factors, chronic stress, and most commonly, the use of antacids and antiulcer medications such as cimetidine and ranitidine.
Low stomach acid is difficult to diagnose, and many different techniques exist that can provide some indication. Hypochlorhydria can be inferred by the presence of pernicious anemia, poor gastric motility, and poor digestion, seen in the iris as a darkish area around the pupil of the eye, and determined from stool samples in which animal proteins will be poorly digested. Low stomach acid is best treated by dealing with chronic stress issues, using bitter herbs such as Gentian (Gentiana luteum) and Barberry (Berberis vulgaris), and broad-spectrum digestive enzymes that include HCl, papain, bromelain, and pancreatin. Additional measures include supplementing with the B-complex vitamins, vitamin C, and taking apple cider vinegar regularly (but not in Candida conditions during the first month of treatment).
Another factor in the equation is the presence of beneficial friendly bacteria such as Lactobacillus acidophilus, Bifidobacterium bifidum, and other microorganisms. Research has shown that these friendly bacteria enhance the capacity of the immune cells in the gastrointestinal tract to defend against foreign pathogens. These immune cells maintain an important link to other cells in the immune system and appear to have a modulating role in immune function. Clinical research has shown that the oral supplementation of friendly bacteria enhances the phagocytic activity of the immune system, and provides sustained immunological protection, both within and without the gastrointestinal tract. Additionally, these bacteria compete with other pathogenic organisms such as Candida albicans and the diarrhea-causing Clostridium difficile.
In our next blog we are going to address factors that contribute the cause of AI and start to unravel solutions to overcome these dramatic conditions.
[1] London’s Francis Crick Institute, Jan 24, 2022
[2] Huan Song, MD, PhD; Fang Fang, MD, PhD; Gunnar Tomasson, MD, PhD; et al; Association of Stress-Related Disorders With Subsequent Autoimmune Disease; JAMA
June 19, 2018