Autoimmunity: Too Much of a Good Thing
A healthy immune system responds to threats to the body, inside and out. Ideally, this response is short-lived and shuts down once the threat is neutralized. The healthy immune response is one that matches the level of threat. When no real threat is present, it does its job by doing nothing. What happens when an immune system remains in fight mode? This condition is simple, in its origin, and complicated in its outcome.
Perceived threat, to a person with post-traumatic stress disorder, or PTSD, can be just as stressful to the body and mind as an actual threat. The misfirings of a stressed-out immune system — one that perceives healthy tissue as an enemy to be neutralized — can also do real damage. Symptoms flare and autoimmune disease ensues. Arthritis, Systemic Lupus, Multiple Sclerosis, Type 1 Diabetes, Psoriasis, Graves' Disease, Hashimoto's Thyroiditis, Vasculitis...there are over one hundred chronic diseases in this category. Every one of them disportionately affects women.
Why does the body mistake friend for foe? Since three-quarters of the immune system resides in the gut, it's not surprising that dysbiosis — a lack of balance in the microbiome — is an underlying cause.
Treatment in a conventional medical office generally focuses on suppressing the immune system rather than eliminating the cause of its overwrought misfiring. When presented with a case of psoriasis, for example, a doctor can choose from more than fifty different prescription medications, many of which block something that the body is producing — a substance that plays an essential role in normal operations. A chemical that causes inflammation, for example. An obvious question would be: what happens if you need that chemical for other important battles the body might wage? Drug companies have candidly warned patients that their immune systems will be less able to fight infections caused by viruses, bacteria, and fungi.
I am partial to differentiating between a last resort and a good place to start, when it comes to treating autoimmune disease. There are less risky ways to begin healing, and these nurturing modalities have a much better shot at long-term success. The benefits extend throughout the whole body. If you would first do no harm, focus on healing your gut and regaining balance in its microbiota.
The immune system developed, in our species, right alongside the microbiome — that veritable zoo of commensal bacterial, home to one hundred trillion microbial cells. Components of the microbiome have a profound effect on immunity and can actually attune the cells called into action by the innate immune system. These microbiota have even been referred to as “instructors” of the immune response. The relationship is a close, symbiotic one and always has been — both in terms of function and in terms of physical location.
When I say much of the immune system resides in the gut, where, exactly, would you find that on a diagram? Our digestive system is lined with lymphatic tissue known as the GALT (gastric-associated lymphatic tissue) which is part of the MALT (mucosal-associated lymphatic tissue.) The cells needed by our immune system are launched, in part, from this gut-based mucosa: macrophage, T cell, B cell, M cell, dendritic cell, IgA-producing plasma cells, stromal cells.
The GALT is vulnerable to damage from diet, antibiotic exposure, steroid use, alcohol and other stressors that create an abnormality in the gut-barrier function. It's the largest mass of lymphoid tissue in our bodies and it's through this thin layer that essential nutrients are absorbed. When functioning properly, GALT also protects the interior of the body from things that shouldn't be absorbed.
Food — even of the organic, heirloom variety — can become a pathogen if it escapes a damaged mucosal barrier too soon. When partially digested food particles, microbes, toxins, and proteins escape through looser junctions in the intestinal wall, the immune system perceives a threat and activates. Some escaping particles provoke a bigger immune response due to their resemblance to other pathogens — something referred to as mimicry. More on that next week when we take a look at food sensitivities.
When a body with a leaky gut lives on high alert, facing down a daily bombardment of “infection,” a whole cascade of problems unfolds. A state of chronic inflammation can destroy cells and tissues in all parts of that body, including the brain, liver, pancreas, lungs, kidneys and thyroid.
Early in my functional medicine career, I took care of a woman in her 30s - let’s call her Taylor - who came to the clinic diagnosed with Hashimoto’s Thyroiditis, or autoimmune thyroiditis. Taylor had been to the endocrinologist and was told, like so many, that she would have autoimmune disease for her entire life, would have to take medication, that there was no cure. This woman was determined to do what she could to be as healthy as possible and to find a practitioner who was willing to work with her. Her primary clinical symptom was fatigue.
The laboratory markers used to diagnose and monitor autoimmune thyroiditis are thyroperoxidase antibody (TPO AB) and anti-thyroglobulin antibody (ATG AB) — tailored antibodies that the immune system has launched due to a perceived threat. Taylor’s levels were, of course, elevated. We went to work and healed her gut through modifying her nutrition and rebalancing her microbiome. She had a gluten sensitivity and, when she eliminated it from her diet, her fatigue diminished, her gut healed, and — low-and-behold — the levels of her thyroid antibodies decreased.
I will forever remember the consult letter I received from the endocrinologist after my patient’s yearly check-in with him. I had known him and collaborated with him for years. I always felt like we had a mutually respectful, good working relationship. In his letter, he acknowledged the resolution of Taylor’s autoimmune thyroiditis, “despite that impossibility within conventional medicine and research.”
His acknowledgment, at the time, was remarkable. The microbiome has now taken center stage in standard medical research. A multidisciplinary approach to autoimmune disease syndromes is bringing specialists to the same table for a shared look at the wide-ranging symptoms caused by a gut in disrepair. That's great news, if it means the body is being seen as an interrelated whole. The not-so-great news is that the goal of these collaborations still tends to be the discovery or deployment of a drug to mask the symptoms of autoimmunity.
Repairing the gut makes more sense. That's where a functional medicine approach is crucial.
Do you have an autoimmune condition? Many symptoms suggest you could be headed for one. These include, but aren't limited to: fatigue, dizziness, difficulty concentrating, hair loss, skin changes or rashes, constipation or diarrhea, and numbness or tingling in hands or feet. More often than not, there aren't indications on conventional medical tests, and the early signs can be easily confused for some other medical or mental health problem.
It's wise to heed these early signs as future symptoms of debilitating autoimmunity. If your condition has already advanced, and you're experiencing multiple autoimmune diagnoses, you might need to get a real campaign to regain your health, underway, with the help of a functional medicine practitioner. I've seen patients back out of a full-blown syndrome that was years in the making.
No matter where you are, in the course of disease, here are some healing steps you can take:
Develop a therapeutic food plan
Start taking a multi-strain probiotic & prebiotic
Make sure you get adequate sleep (and high-quality sleep)
Build movement and exercise into your day
Reduce your exposure to stress and toxins
Autoimmune disease can be reduced or reversed by decreasing intestinal inflammation. The strength of the immune system, as well as the prevention and response to infection and the recovery from illness, is related to the strength and diversity of the microbiome. It's that simple...until it gets complicated!
This series of “doable” weekly-ish installments, focused on gut health and immunity, is designed to help you understand the ways in which your defenses might be down and your overall health degraded. It’s meant to empower you to act in measurable and realistic ways. In the middle of a global crisis, you can take it upon yourself to get stronger. I want to help you understand your vulnerabilities and suggest ways you can realistically improve your health. Chances are, these are changes your body has been asking you to make for a while now.