A tangled Mess: Addressing the Knots of Autoimmune Conditions
As I’ve talked about in my first two articles on autoimmunity, researchers are beginning to find out more about the mechanisms behind what triggers autoimmune conditions. In this article, I discuss some possible triggers that play a role in the development of autoimmune conditions.
Think of autoimmunity as a bundle of knotted yarn. Everyone looks at the yarn and thinks, “I don’t really want to mess with that!” This is how autoimmune conditions look to most doctors. In functional medicine, we are used to looking at these messes. The more you look at them, the easier it gets to sort through the mess.
For some patients, the doctor can methodically search through and find the direction that helps untangle the mess. For others, this bundle of knots has been left to roll around in the knitting bag for years and has knots that require someone to tease through carefully. These cases take more commitment by both patient and doctor. In either case, the yarn never quite looks the same and is prone to tangle again if not handled properly in the future.
In many individuals, the autoimmune condition is a burden, yes, but by addressing root issues and watching their triggers, they can live an abundant life. For others, the disease process has become so complex and advanced that they can gain a lot of function back, but it will take longer and there will be limitations. They may need multiple therapies to put their autoimmune condition into remission. And that’s what it's all about- remission. You can never get rid of or cure an autoimmune condition, but remission is a sweet place to be for the autoimmune patient.
I started out as my own autoimmune “mess.” I was very sick for a little over two years. If you don’t know my own personal story, you can read it here. My health was so far gone that it took me just over two years of working on my own health before I felt really good again. This was largely due to not being diagnosed properly and not being with a doctor that was autoimmune literate. My personal experience with an autoimmune condition helped me realize that there was a need for more doctors who work with autoimmune conditions. Functional medicine (or nutrition) is the perfect vehicle for this.
The thing you need to remember is that autoimmune conditions can be very elusive to those who are not accustomed to working with them; they are also complex or multifactorial. That’s why they are missed often. Both working on your diet and taking supplements for gut health are not enough. They may show some marked improvement, but you will miss a lot of key factors if that’s all you do. Below I have listed the most common problems I find in my autoimmune patients.
GENETICS:
The triggers discussed below (environmental, gut health, infections) will create the autoimmune condition you are genetically prone to develop. Family history is very helpful when determining what that could be. If you have a family of people with Hashimoto’s, then that may be what you develop if the triggers needed to push you into that condition are present.
Two fairly common genetic mutations that I see in my patients are the HLA gene mutation and the MTHFR gene mutation. With the HLA gene mutation, patients have trouble detoxing from mold exposure and generally become inflamed by a variety of catalysts, including mold, Lyme disease, other toxins, or gluten. The HLA gene mutation is associated with a variety of autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus, type I diabetes, celiac disease, and multiple sclerosis. The MTHFR mutation will also cause issues with detoxing properly, as well as issues with hormone balance and immune system function. It has been associated with autoimmune conditions such as fibromyalgia, Hashimoto’s, and lupus.
These are only two genetic mutations that may make you more susceptible to an autoimmune condition. There are hundreds of genetic panels that can be helpful in determining your individual genetics. These can be supported to bring about a better outcome in care.
ENVIRONMENTAL TRIGGERS:
Mold - Mold can lead to immune dysregulation, which can cause a whole host of problems. Those who have mold exposure, and especially those who are genetically susceptible, can develop a lack of tolerance to their environment, which may include developing food allergies, food sensitivities, and chemical sensitivities. This lack of tolerance can turn into autoimmunity.
Toxins - There are a large number of toxins that are suspected to contribute to autoimmune conditions. Some of these include mercury, iodine, vinyl chloride, organic solvents (1), hydrazines, tartrazines, cadmium (2), formaldehyde (3), trichloroethylene, and asbestos (4) to name a few. The above toxins can be found in things that we encounter every day, such as household cleaners, personal care and cosmetic products, building materials, pesticides, processed foods, and vaccinations. Sources of such toxicity can be small doses that build over time or large exposures.
Though completely avoiding toxins is impossible in this day and age, be mindful about materials and products you bring in your home and workplace, what personal care products you use, and what foods you put in your body. Additionally, investing in a high-quality air purifier at home or at work can be extremely beneficial for your health. Our practice is a distributor for the Austin Air Purifiers. Call the office if you would like to invest in the air quality of your home or workplace.
GUT HEALTH:
We are learning that gut health is extremely important to prevent autoimmune conditions (5, 6, 7). Common gut problems I find in those with autoimmune conditions are listed below. Note that these things can drive the development of autoimmunity or be a result of an autoimmune condition.
Poor Diet - It’s important to pay careful attention to our diet, as each food that we eat can feed either good or bad bacteria. When there is an imbalance of good and bad bacteria in the gut ecosystem, we have what is called “dysbiosis.” When the gut ecosystem is not balanced, pathogenic bugs can take over, which can trigger autoimmune disease (8).
Intestinal Permeability or “Leaky Gut”- While our intestinal lining should be tightly wound, leaky gut (caused by food sensitivities, stress, poor diet, or infections) means that the lining is permeable and allows large compounds to enter our bloodstream. Pathogenic bacteria and undigested food particles can easily travel from the small intestines to other parts of the body and trigger these autoimmune reactions.
SIBO - SIBO, or small intestinal bacterial overgrowth, is a condition where there is extreme dysbiosis in the small intestine, which sometimes also means there is bacterial overgrowth in the large intestine. Although we are still learning about the mechanisms behind it, SIBO is connected to autoimmune conditions, such as irritable bowel syndrome, scleroderma, celiac disease, and Hashimoto’s (9).
Food Allergies/Sensitivities - Undetected food allergies and sensitivities can be a major problem in health and the development of autoimmune conditions. If you are regularly consuming foods that your body is reacting to, you are continuously putting your body in an inflammatory state. Food intolerance may be connected to various autoimmune conditions. An obvious example would be celiac disease, in which gluten is the major trigger (10).
Focusing on gut health is always an integral part of both treating autoimmune conditions and preventing the development of autoimmune conditions.
INFECTIOUS TRIGGERS:
Various types of infections can be a huge driver of autoimmune conditions. Interestingly, certain infections will drive autoimmunity toward certain tissues or parts of the body. Understanding infections can help guide you on what autoimmune conditions to screen for.
Epstein-Barr Virus (EBV) - EBV usually infects people in early childhood. In early childhood infection, the virus causes only a mild illness and sometimes even results in no symptoms at all. For teens and young adults, the infection can cause mononucleosis or “mono.” After infection, EBV stays in the body and remains dormant. However, research has found a link between EBV and systemic lupus erythematosus, or lupus. There’s evidence that EBV infection can be reactivated and trigger this autoimmune condition (11). A viral protein in EBV infected cells may activate genes associated with autoimmunity (12). In addition to lupus, EBV has been associated with multiple sclerosis, rheumatoid arthritis, juvenile idiopathic arthritis, inflammatory bowel disease, celiac disease, and type I diabetes.
Human herpesvirus 6 (HHV-6) - HHV-6 has been associated with several different autoimmune diseases, including multiple sclerosis, autoimmune connective tissue diseases, and Hashimoto’s thyroiditis. There are several proposed mechanisms for these conditions’ associations with HHV-6. The proposed mechanisms include molecular mimicry, which is when the virus mimics the antigens of the person’s cells whom it has infected. This triggers the body to attack its own tissues. Other proposed mechanisms include endothelial cell damage and cell death (13).
Lyme disease - Lyme borreliosis is an inflammatory disease from the spirochaete Borrellia burgdorferi, which is transmitted through a tick bite. Oftentimes, antibiotics take care of the infection, and the person can move forward like normal. However, if antibiotics don’t eradicate the infection completely or if the infection goes undetected, long-term exposure to spirochaetes or borrelial compounds may trigger autoimmune conditions. The bacteria can cause proinflammatory reactions in the body as well as immunomodulatory-immunosuppressive reactions (14).
Herpes Simplex Virus - Type 1 (HSV-1) - HSV-1 is generally transmitted through oral secretions or sores on the skin. It causes sores around the mouth and lips and in some cases, can cause genital herpes. Once a person has the virus, it stays in the body. It will lie dormant until it’s triggered to become active once again (15). Like HHV-6, it also has the capability to trigger autoimmune conditions. One proposed mechanism for HHV-6 is again molecular mimicry, where the virus mimics the antigens of the host’s cells. This causes T cells to destroy the person’s own tissues (16).
H. Pylori - H. pylori is a very common stomach infection. It’s estimated that more than half of the people in the world have it. Generally, people don’t get sick from H. pylori, so they never know that they have it, but symptoms of it may be abdominal pain, nausea, bloating, unintentional weight loss, frequent burping, or if you’re diagnosed with a peptic ulcer. H. pylori has been associated with immune thrombocytopenia, which is an autoimmune disease where the immune system attacks blood platelets. Though the pathogenesis is yet again not completely understood, it’s suspected that molecular mimicry occurs between one of the H. pylori antigens and platelet glycoproteins, which then causes the production of cross-reacting autoantibodies (17). H. pylori is suspected to play a role in various other autoimmune conditions as well, and research has shown that patients often improve once the underlying infection is addressed (18).
Fusobacterium - Fusobacterium is a rod-shaped gram negative bacteria that is normally found in the gastrointestinal, oral, and genital flora. However, certain species of Fusobacterium are opportunistic and may play a role in autoimmunity, specifically in Crohn’s disease (19). Because fusobacterium is gram-negative, it is fairly resistant to many drugs and antibiotics.
In my practice, we specialize in sorting through the knotted mess of autoimmune conditions. With the right tools, we are able to pinpoint problems that can go unrecognized for years. The earlier an autoimmune condition is detected and root issues resolved, the better the chance there is for recovery. I believe that our method of sorting through complex conditions, like autoimmune conditions, allows us to be successful in helping individuals reach remission.
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