Autoimmune (AI) diseases are becoming more common in developed countries. Physicians agree this problem is currently intensifying, some using the language of epidemic proportions. There is not a well-defined mechanism of action behind these diseases. AI disease is an umbrella term for a disease in which human pathophysiology turns on oneself and begins to attack itself. The immune system is described as hyper-active. This can happen anywhere in the body. In fact, there are 100+ autoimmune diseases, from rheumatoid arthritis, Crohn’s disease, multiple sclerosis, to more rare diagnosis’ such as antiphospholipid syndrome.
Hygiene Hypothesis
The ‘hygiene hypothesis’ questions if too clean of an environment is associated with an increased risk of AI disease. Evidence seems to support the theory that germs help educate and regulate your immune system. For example, there is correlation between the rise in cesarean sections and the rise in AI disease. The mechanism is the absence of interaction with the vaginal flora. The hygiene hypothesis is extrapolated to other aspects of infancy and childhood. Breastfeeding offers the transmission of antibodies as well as beneficial bacteria from the mother’s milk to the infant. Being breastfed was associated with a lower incidence of diabetes, celiac disease, multiple sclerosis and asthma, explained by the protection against early infections, anti-inflammatory properties, and regulation of infant’s microbiome. It has been speculated that having siblings can reduce the likelihood of developing AI diseases. A questionnaire-based study found children whose families washed dishes by hand versus using a ‘sterilizing’ dishwasher had significantly less eczema, hay fever, and asthma. Other sources of ‘good germs’ for kids can come from playing outside. This is supported by a study that showed chronic subjection to farm dust helped lower the allergic tendency towards house dust mites.
The microbiome is an ecosystem of microbes living in a human, mostly concentrated in the intestinal tract. It can be negatively affected by the aforementioned lifestyle factors as well as stress and lack of exercise. The microbiome is often measured by its diversity and abundance of microbes. A recent study pointed out that decreased diversity and a shift towards inflammatory microbes usually precedes the onset of Type 1 Diabetes in children with genetic risk factors.
Speaking of genetics, certain genes with various single nucleotide polymorphisms (SNPs = genetic variations) have been linked as risk factors for AI disease. However, this is never perfect because there are many genes at play, and the environment that governs the genes is always changing.
Leaky Gut
We are supposed to digest food in the intestinal tract and absorb the micronutrients into the blood. However, if there is inflammation present from excess stress or an inflammatory diet, then the intestinal walls become more permeable. This leads to extravasation of food proteins from the intestinal tract into the lymphatic tract, a major part of your immune system. Here you may make antibodies against foreign invaders, or in this case, food proteins like gluten. These antibodies will look for certain protein patterns to attack and destroy. The theory is that these antibodies not only attack food proteins but turn and attack certain tissues in your body with similar protein patterns.
Stress
Based on correlation studies, AI diseases seem to begin after significant stressors. Perhaps this goes along with the leaky gut theory above. Infection is considered a stressor, and we see AI diseases stem from certain infections known as enteroviruses, specifically coxsackie virus. It is thought that the coxsackie virus may have a similar protein pattern as pancreatic beta cells. So, when the immune system attacks the virus, the pancreas ends up being attacked and losing the cells responsible for making insulin, rendering Type 1 Diabetes. Also, postpartum, whether blissful or challenging, seems to be a common time where AI disease processes begin. Physical-mental-emotional trauma has also been a commonality in the predisposition of AI disease.
Lifestyle Modifications
Reduction in inflammatory burden is most important. Nutrition is the best place to start, since we make this decision 2-5 times a day. Figuring out one’s food sensitivities is important so these foods can be avoided. Working with a qualified practitioner, a patient may do a food elimination protocol with re-introduction or get objective information from a blood test. Elimination is more important than supplementation, but a nutraceutical protocol aimed at anti-inflammatory support and rebuilding the intestinal wall is indicated. The Autoimmune Protocol Diet (AIP) is gaining traction for management of AI diseases, which restricts several major food groups: grains, dairy, eggs, nightshade vegetables, nuts, seeds, legumes, and more.
Promoting a healthy microbiome is necessary. An anti-inflammatory diet will promote this by eliminating processed foods. Physical activity is one of the best things you can do to make positive shifts in your microbiome. Probiotic supplementation supports a healthy microbiome as well.
There are immune modulating nutraceuticals with a growing body of research to support them. For example, Echinacea spp. is an ancient plant medicine that recently was considered as an immune-stimulant. The mechanism of immune stimulation would not be good for AI disease, and some warn against using Echinacea for AI disease. However, there is no evidence that echinacea worsens AI disease, in fact physicians a few generations back were using Echinacea to manage Rheumatism.
If you have an AI disease, then you may be managed on a steroid medication or a biologic immunotherapy. Naturopathic medicine can complement these medications and serve as a palliative treatment to the potential side effects. For example, steroid medications deplete magnesium, thus it is wise to monitor serum magnesium levels and be keen to symptoms of magnesium deficiency. Another wise choice, for everyone, is to avoid getting vaccinations around a time of a cold or infection as recommended by the Centers for Disease Control and Prevention (CDC).
There is no cure for AI diseases, however Naturopathic medicine does a promising job to reduce the burden of the diagnosis. I suggest finding the right care team and welcome lifestyle changes for the best.
Dr. Nick Edgerton, ND, LAc, is a licensed Naturopathic Doctor and Acupuncturist at Collaborative Natural Health Partners in Manchester, CT. He is an in-network provider with most major health insurance companies. Please call 860-533-0179 for an appointment.