Autoimmunity – A Functional Medicine Approach
Normally, when the immune system recognises what it thinks is a harmful protein or chemical from environmental toxins, metals, undigested food or inhaled material and infections, it registers that these proteins are not ‘self’ and attacks.
The accepted principle of autoimmune disease is that one’s immune system mistakenly attacks its own body tissues. Research has not yet isolated the actual cause of this, but infection and toxins possibly associated with specific gene types is considered likely (1).
One theory suggests autoimmunity occurs because of a process known as Molecular Mimicry. This occurs when proteins, and other molecules, enter the body and the bloodstream, and look like (‘mimic’) the proteins that are making up our body tissues. If our immune system attacks these proteins, as it should, we can end up with our immune system attacking our own tissues by mistake. The attack is marshalled by defence compounds called autoantibodies.
A second theory is that damage and altered structure to one’s own cells occurs when they are attacked by infection or a toxin. This causes the immune system to mistake these cells, now with altered structure or behaviour, as being an invader. Again, autoantibodies are formed.
As autoimmunity can attack different parts of the body, patients are referred to different conventional specialists and treatment is geared towards suppression of the immune response and not aimed at the underlying dysfunction of the immune system or isolation and removal of the cause.
Conventional GPs & specialists most often prescribe steroids in the initial acute phase to quell the overactive immune response. Then, to reduce the effects of the disease, further medication is added - such as immune suppressive drugs, disease modifying drugs (effectively stringer steroids, stronger anti-inflammatories and immune altering medication called monoclonal antibodies), pain killers and in the case of the thyroid, thyroxine replacement etc.
Functional medicine practitioners try to isolate possible underlying cause and focus on correcting immune behaviour. Doctors practising Functional Medicine will take the best path for a patient from both conventional and alternative therapies.
The more common of the 40 plus recognised autoimmune diseases that frontline doctors are faced with are:
- Thyroid disease – Hashimoto’s (Autoimmune Hypothyroid) & Grave’s disease (Autoimmune Hyperthyroid). The thyroid seems particularly sensitive for many reasons to being attacked. (2)
- Pernicious anaemia (leading to Vitamin B12 deficiency)
- Inflammatory Bowel Disease, including Crohn’s, Coeliac and Ulcerative colitis.
- Rheumatoid arthritis
Other diseases that patients and doctors are less frequently faced with are:
- Psoriasis,
- Vitiligo,
- Multiple sclerosis,
- Arteritis (inflammation of the arteries)
- Urticaria,
- Lichen planus
- Diabetes
- Systemic lupus erythematosus (lupus).
I consider that conditions that remain undiagnosed or whose description ends in ‘…itis’ but have no obvious cause, are likely to fall into missed cases of autoimmunity.
Theories behind the causes of autoimmunity
The following list gives the possible causes of molecular mimicry, cellular damage leading to structural or cellular behavioural change or both. Treatment or investigation needs to be aimed at these areas
- A “Leaky gut” allows undigested foods, bowel bacteria, viruses and yeasts to enter the blood stream, through the gut wall barrier triggering an immune response. This causes molecular mimicry. Please see the link on my web site or, if this document has been emailed to you, please the attached information sheet.
- Infection. Severe or long standing (chronic) infection is sited by a program called the Marshal Protocol (3) as a major cause of autoimmunity. It suggests that autoantibodies are not the cause of the attack on ‘self’ but are attacking the infection. The problem is infection and not the immune system being overly active or ‘wrong’ at all.
It is also theorised that chronic infection can lead to an ‘Upregulation’ of the many metabolic processes and chemical messengers from specific white blood cells which tells the immune system as a whole to ramp up its activity and attack on ‘self’ is collateral damage. - Inflammation. When infection, toxins or food allergy/intolerance affect tissues or cell membranes, the immune system will try and attack and remove these. In doing so tissues and cell proteins in the neighbouring tissues become damaged and altered. The immune system, in time, can then mistakenly starts to attack what it thinks is not ‘self’.
- Physical Trauma. Physical trauma leads to altered and damaged cellular structure, inflammation and increased white cell activity. Again, this may lead to antibodies attacking our own proteins, thereby becoming autoantibodies. This is more likely, perhaps, if the injury becomes chronic (lasting a long time)
- Psychological Stress – adrenaline and other stress hormones can “up-regulate” the immune system. To counteract stress the body produces cortisol which is considered a ‘modulator’ of immunity. Cortisol initially supresses inflammation (to reduce damage to the area), enhances some immune response whilst supressing of other responses. Poor cortisol production and modulation can lead to incorrect immune response. Stress may also alter gene activity.
- Hormones When increased cortisol demand is required, due usually to chronic stress – physical or psychological, Progesterone levels can be reduced. Progesterone can suppress certain immune responses so loss of this hormone can lead to excessive inflammation and excessive immune response can occur. Another hormone which is part of the stress pathways, DHEA, can also influence immune response and is a pre-cursor to oestrogen and testosterone.
- Toxins – Metals, environmental pollutants, food allergy, particularly grain proteins such as glutens and gliadins, can trigger leaky gut and inflammation.
- Genetics. As humans evolved, specific genes developed to control our immune.
Relevant investigations.
Tests or investigations should only be considered if it is likely to alter diagnosis or therapeutic approach. In the case of autoimmunity, it is important to try and highlight one or more of the theoretical underlying causes so that therapy can be specifically aimed and designed. In my opinion the following tests are of importance:
A leaky gut test - see accompanying information.
Comprehensive digestive stool analysis (CDSA). If a leaky gut is shown to be present or if the history of development of the autoimmune issue has any association with bowel infection or the use of antibiotics, then establishing whether bad bacteria, yeasts or other fungi and parasites are present is important. Such stool tests indicate what compounds may remove these organisms and also tell us if there is enough of the beneficial bacteria such as Lactobacillus and bifidobacteria. CDSA will also highlight inflammation in the gut and measure a compound known as secretory IgA which reflects both bowel and general immunity.
Tests through blood and urine establish if an individual is toxic or if the immunity is sensitised to heavy metals and many common toxins to which we are exposed through the environment.
Blood tests to highlight chronic infection can be followed by specific tests, such as those for Lyme disease and its co-infections including herpes and especially Epstein-Barr virus (EBV) which is sited as a cause for several autoimmune conditions.
Testing for food intolerance can be considered if an individual has a history of recognition of health issues associated diet.
Adrenal stress profiling, hormone assessment for oestrogen dominance and measuring neurotransmitters not only gives evidence of a stress response that is being poorly controlled but can also advise on what natural therapeutic options can be considered to bolster the calming and relaxing neurohormones that can quell excessive immune response.
Therapeutic considerations.
Obtaining a full and time-lined medical history is paramount as it may clearly indicate which of the above causes is most likely.
It is always important to establish healthy lifestyle, diet and nutrition and exercise. Each area influences immune response as does, perhaps most importantly, a healthy Psycho-spiritual approach to life.
Once underlying cause is established through consultation, medical history, and examination and/or through tests and investigations then integrated treatment needs to be aimed at a combination of any of the following:
Bowel health
Stress response
Detoxification
Diet and possible food exclusions
Anti-inflammatory therapy
Anti-infective treatment
Hormone balance
References
- https://medlineplus.gov/ency/article/000816.htm
- https://www.karger.com/Article/Fulltext/324442
- https://mpkb.org/home/alternate/autoimmunity#rethinking_autoimmunity
