According to the National Institute of Health (NIH) anywhere from 5 to 8 percent of Americans are living with an autoimmune condition. The incidence rate has been rising steadily over the past fifty years, especially in younger populations. These statistics are just taking into account medically diagnosed cases. The prevalence of less severe autoimmune cases such as eczema, irritable bowel syndrome, and asthma are not even considered in this tally. Furthermore, new autoimmune pathways are being discovered every day that affect conditions ranging from type 2 diabetes and Alzheimer's to cardiovascular disease and even some types of cancer.
In this post we will cover the mechanisms of autoimmunity, the most common types of autoimmune diseases, and what we can do about them. As always a section on Chinese medicine will be included.
The Immune System: Introduction
The mammalian immune system is arguable one the most complex physiological arrangements that has ever existed; it's even on par with the human nervous system. Consisting of trillions of unique cells, across many different cell types, our immune system is responsible for the defense and repair of the human body. When dealing with acute stressors, it demands huge amounts of energy, evident in the fatigue that occurs during a sickness.
The immune system consists of an innate branch and an adaptive branch. The two work in conjunction to ward off external pathogens and also initiate programmed cellular death. The immune system is the army, the police, and the waste management service all rolled into one. In order for these processes to work smoothly, the immune system undergoes a rigorous training protocol.
Immune Maturation
The immune system begins its process of maturation in early infancy. The thymus, an organ located below the sternum is highly active during this time and serves as the school, so to speak, for the lymphocytes (a.k.a. white blood cells) that are responsible for running the immune response. The specifics of what exactly occurs are still not fully understood, but in essence these lymphocytes are exposed to the body's own cells in order to get them to bind to them but not too strongly.
In order for the immune system to function properly it must be able to recognize the difference between healthy cells and unhealthy ones. Unhealthy cells are either infected by a pathogen (like a bacteria or virus), or are signaling for destruction due to internally programmed cell death. The white blood cells, bind to a receptor on the surface of these 'sick' cells that signals that they are ready to be eliminated. Each time that this happens, the immune system 'learns' what is and what isn't dangerous.
The immune system doesn't gain full maturity until a person reaches their 20s or even 30s, and even then, it never stops learning. This slow maturation is one of the reasons why the majority of autoimmune disorders begin in adolescence or early adulthood. The idea behind this is that immature white blood cells do a poorer job at differentiating self from non-self, and can more easily be triggered into an autoimmune response.
The Autoimmune Response
While the specifics of each type of autoimmune condition are unique, they all share one element in common; the immune system is attacking the body's healthy cells, resulting in a process of inflammation and loss of function. The response begins when white blood cells mistake normal cells for ones marked for destruction.
The exact triggers for this mistaken identity can vary widely but usually involve some combination of the following elements: 1) high systemic inflammation, caused by sensitivities to food and environmental toxins; 2) dysregulation of hormones and immune cytokines, caused by high levels of cortisol; 3) genetic predisposition to autoimmunity, which loads the gun for a possible inflammatory cascade; 4) viral or bacterial (including vaccines) challenge to the immune system, which pulls the trigger on that cascade.
Once an autoimmune attack is initiated, it can take months and sometimes years for symptoms of the autoimmunity to show up. By the time it gets to a point of diagnosis, the patient is already deep into a chronic and cyclical inflammatory pathway. To break out of this cycle, major changes in lifestyle are necessary, and often patients need the temporary assistance of pharmaceuticals to suppress the runaway immune response. In some cases like Hashimoto's thyroiditis and type 1 diabetes, the patient will have to indefinitely take replacement hormones to compensate ones that were produced by the destroyed cells.
Types of Autoimmunity
While in no way an exhaustive list, the following are the most common forms of autoimmune diseases:
Hashimoto's Disease
Grave's Disease
Type 1 Diabetes
Myasthenia Gravis
Systemic Lupus Erythematosus
Scleroderma
Sjogren's
Eczema
Psoriasis
Vitiligo
Alopecia
Multiple Sclerosis
Rheumatoid Arthritis
Crohn's Disease
Mixed Connective Tissue Disorder
Fibromyalgia
Put simply there are as many autoimmune disorders as there are types of tissues in the human body.
Treating Autoimmunity
The process of treating autoimmunity is the same as reverse engineering the factors that promote it. Systemic inflammation and stress must be lowered and the immune system must be allowed to return to homeostasis. Treating stress would cover an entire post on its own, so we'll focus on how to lower inflammation first.
The most common place of origin for systemic inflammation is in the gut. The gastrointestinal system is home the majority of the body's immune cells because it is the frontline for pathogenic invasion. This is a good thing if we are defending against bacteria and virus, but a bad thing if we are attacking proteins and other nutrients that permeate the gut lining. Permeability is increased by exposure to environmental toxins like pesticides, industrial cleaners, alcohol, and tobacco. Excess stress, an unhealthy gut microbiome, and consumption of high inflammatory foods also contribute to a breakdown of the tight junctures that keep the intestinal lining intact.
Over time, undigested proteins make their way into the bloodstream and the immune system, which sees them as intruders, mounts a defense. This is the beginning of systemic inflammation. In some cases, the proteins that are being targeted share similarities to proteins on the surface of some of our cells, and the immune system inadvertently attacks these healthy bystanders. A real life example of this is part of the gluten molecule resembling receptors on the thyroid gland. Antibodies to the gluten molecule, could theoretically also mark the thyroid for destruction.
It follows from this that maintenance of the integrity of the gut lining and elimination of harmful substances is paramount in preventing, and reversing the process of autoimmunity. There are many DIY versions of autoimmunity diets--the paleo diet, the FODMAP diet, AIP diet, and the Westin A. Price diet. They are all attempting to exclude the harmful food categories, giving the intestines and immune system time to rest, However, there is usually not a one-size-fits-all approach and many of these diets do not accurately address how to rebuild beneficial gut flora. Working with a functional doctor to identify your specific food sensitivities and create a more healthy microbiome could save a lot of wasted time and effort.
Autoimmunity and Chinese Medicine
Chinese Medicine (CM) views inflammation primarily as excess heat and stagnation in the body. The source of this heat varies and could be from completely different etiologies. For instance, a patient suffering from Grave's might have a large amount of Liver blood and/or yin deficiency, which gives rise to false heat. Or a different patient with Grave's could have stagnation of the Liver qi, which produces true heat. A patient suffering from rheumatoid arthritis might have heat related to excess phlegm caused by a deficient Spleen. Or a patient with RA could be suffering from deficiency of Kidney yang with excess cold.
A typical treatment protocol for any autoimmunity will focus on clearing heat, while supporting any underlying deficiencies. A combination of acupuncture, herbs, and diet is often necessary. CM looks at the function of the digestive system as vitally important in treating autoimmunity, and will introduce foods to promote ease of digestion, while eliminating those that are causing problems. This will often parallel exactly with approaches taken by functional medicine doctors
Conclusion
Amongst the so-called diseases of Western civilization, autoimmunity is one of the most complicated. There is a combination of conditions that must be met for it to proceed, and many of the conditions remain occult even after diagnosis. Traditional Western medicine fails to address the lifestyle bases causes for these disease, relying too heavily on immunosuppressants and anti-inflammatory medications instead. To tackle the problem more systemic thinking is required. We must not only look at the problems in a current patient but the ones that have a accumulated in the past generations. Environmental toxicity more often than not accumulates and generationally inherited food customs are difficult to transcend.
Not surprisingly, there is a growing body of evidence linking autoimmunity to unresolved psychic trauma. In the process of survival, the developing child (and immune system) may find it easier to attack parts of themselves, than face the shock of abandonment and terror related to facing reality. For more information on that check out the last post about mental health.
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