Integrative strategies for supporting increasing prevalence of early autoimmunity

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By Carolina Brooks, BA, IFMCP

I would gauge that at least 60 percent of patients who come into my office are at the end of their tether. There are certain scenarios that point to a patient who is experiencing undiagnosed autoimmune issues and loss of oral and environmental tolerance. Those patients have had symptoms for many years, often after a triggering event such as a food poisoning incident, a traumatic brain injury from a car crash or sporting accident, or a significant traumatic event, yet their bloodwork and other investigations are deemed normal. They have seen multiple specialists, and been passed around the medical system and have had no resolution of symptoms. Other clues include increasing reactivity to foods and an inability to tolerate smells such as perfumes or detergents.

The prevalence of autoimmune disease is increasing, and causal factors are so variable and complicated to identify that unless a clinician is spending a substantial amount of time with a patient doing a thorough intake and doing relevant testing, it’s hard to understand what is going on and how to support these patients.

There are three stages of autoimmunity:

1. Silent autoimmunity where there are no noticeable signs and symptoms, but predictive antibodies are present.
2. Autoimmune reactivity, where there are symptoms related to the positive antibodies present but no evident tissue destruction. For example, a patient with thyroid antibodies, palpitations might be present, and no tissue destruction causing thyroid-stimulating hormone levels to increase.
3. Autoimmune disease, where tissue destruction and positive antibodies are present. For example, where cerebellar antibodies are present, there is destruction to the cerebellum present on MRI, and signs and symptoms such as unsteady gait, slurred speech, and impaired coordination.

The American Autoimmune Related Diseases Association, Inc. (AARDA) estimates that there are over fifty million Americans suffering from autoimmune disease. This is twice the number quoted by the National Institutes of Health (NIH). The discrepancy in numbers may be due to varying stages of diagnosis. It can take up to twenty or thirty years for autoimmunity to be diagnosed. At this point, it’s likely that tissue destruction has already started to occur and progression to full blown autoimmune disease is well underway.

Regardless of which statistics you consider correct, what is indisputable is that the prevalence of autoimmune disease is increasing, and we must look at triggers beyond gut microbiome imbalances and gut permeability, at other factors such has loss of tolerance to environmental toxins rather than just a high toxic body burden, possible cross-reactive foods rather than simply a diet high in inflammatory refined carbohydrates and saturated and damaged fats, and how a patient regulates blood sugar rather than how much of the diet is carbohydrates. Loss of resilience to stress, emotional trauma, and pathogenic triggers may also induce loss of tolerance to self.

This topic has been brought to the fore this past year during the pandemic. A 2020 review in Journal of Autoimmunity links the triggering of autoimmune processes to SARS-CoV-2, the virus that causes the novel coronavirus (COVID-19), while a 2020 paper in Clinical Immunology saw potential antigenic cross-reactivity between SARS-CoV-2 spike protein antibody and tissue proteins such as transglutaminases 2 and 3, myelin basic protein, thyroid peroxidase, collagen, mitochondrial nuclear antigen, α-myosin, S100B expressed by astrocytes, and claudin 5+6 expressed in tight junctions of epithelial cells, which indicates the significance of pathogenic triggers in the pathogenesis of autoimmunity.

A 2010 paper in The Journal of Allergy and Clinical Immunology notes that aside from autoantibodies, which can even be present in healthy subjects, potential findings in autoimmunity which reflect chronicity of disease might include normochromic, normocytic anemia, elevated or decreased white blood cell or platelet count, or raised inflammatory markers, including C-reactive protein (CRP), ferritin, erythrocyte sedimentation rate (ESR), ceruloplasmin, fibrinogen, haptoglobin, or albumin, many of which can increase in response to tissue injury. Anti-nuclear antibody (ANA) is traditionally considered a hallmark of systemic lupus erythematosus (SLE), although ANA may be raised in other autoimmune diseases as this marker lacks specificity.

Testing total immunoglobulin levels help us to understand B cell function, as well as if infection or inflammation is present and this is something I always do before recommending a patient does more specialist testing, such as multi-tissue antibody testing. Some patients may have such significant protein malabsorption issues that they are not even able to produce adequate immunoglobulin levels, and, in those cases, results may be skewed and look falsely normal. It’s important to reestablish immune balance and restore mucosal immune barriers, not just by focusing on the gut, but also considering the lungs, nasopharynx barrier and the blood brain barrier.

A 2015 article in Journal of Clinical Biochemistry and Nutrition discusses the positive impact of polyphenols on the colonic environment, intestinal barrier function and on immunoglobulin A and fecal mucin levels. Foods I recommend in clinic, and which are identified as rich dietary sources, according to a 2010 paper in European Journal of Clinical Nutrition, include bilberry, olive oil, flaxseed,  aronia, cocoa, rosemary, thyme, ginger, cinnamon, and oregano. Supplements which also have beneficial impact include colostrum, high dose vitamin A, Baikal skullcap, and Astragalus membranaceus (astragalus). Nebulizing glutathione can also be helpful for supporting mucosal immune restoration.

Targeted questioning can also provide insights as to how a patient’s immune system is functioning. Ask patients about how often they suffer seasonal illnesses, whether they are susceptible to gastrointestinal infections, and how they respond to illness, whether they bounce back quickly or whether it takes them a while to recover. Practitioners should ask their patients whether they have ever reacted badly to any supplements or herbs. Certain herbs, such as Uncaria tomentosa (cat’s claw), Echinacea angustifolia (echinacea), or medicinal mushrooms such as Grifola frondosa (maitake) are immunostimulatory, so can make a patient flare and feel worse. Practitioners must be cautious in their recommendations and design a protocol to support them according to what can be tolerated.  

References

Castro, C. and Gourley, M. (2010) Diagnostic testing and interpretation of tests for autoimmunity. The Journal of Allergy and Clinical Immunology. Retrieved from: https://doi.org/10.1016/j.jaci.2009.09.041

Pérez-Jiménez, J., Neveu, V., Vos, F., and Scalbert, A. (2010) Identification of the 100 richest dietary sources of polyphenols: an application of the Phenol-Explorer database. European Journal of Clinical Nutrition.  Retrieved from: https://doi.org/10.1038/ejcn.2010.221

Rodríguez, Y., Novelli, L., Rojas, M., De Santis, M., Acosta-Ampudia, Y., Monsalve, D. M., Ramírez-Santana, C., Costanzo, A., Ridgway, W. M., Ansari, A. A., Gershwin, M. E., Selmi, C., and Anaya, J. M. (2020) Autoinflammatory and autoimmune conditions at the crossroad of COVID-19. Journal of Autoimmunity. Retrieved from: https://doi.org/10.1016/j.jaut.2020.102506

Taira, T., Yamaguchi, S., Takahashi, A., Okazaki, Y., Yamaguchi, A., Sakaguchi, H., and Chiji, H. (2015) Dietary polyphenols increase fecal mucin and immunoglobulin A and ameliorate the disturbance in gut microbiota caused by a high fat diet. Journal of Clinical Biochemistry and Nutrition. Retrieved from: https://doi.org/10.3164/jcbn.15-15

Vojdani, A. and Kharrazian, D. (2020) Potential antigenic cross-reactivity between SARS-CoV-2 and human tissue with a possible link to an increase in autoimmune diseases. Clinical Immunology. Retrieved from: https://doi.org/10.1016/j.clim.2020.108480