Autoimmunity is a broad condition that has been segmented by medical specialties. There are over 80 different diagnosable autoimmune diseases and they are all treated in different, yet somewhat similar ways with the ultimate goal being to suppress the inflammatory immune response. However, in conventional medicine the patient is never regarded in a holistic way.
Patients find themselves running to many different specialty doctors who are not communicating with each other, but rather are subscribing different medications for each ailment. There might be gastrointestinal symptoms, skin issues or joint problems. Patients can end up with handfuls of prescriptions but no long term cohesive plan.
It’s frustrating to talk to a doctor yet never get to the bottom of why this has happened. The conventional approach is to essentially put a patch on the problem with stronger and stronger medications, while the disease progresses. That said, when there is a severe flare of the symptoms, these strong medications are useful and appropriate.
The holistic approach looks at the entire list of symptoms and tried to get to the basic pathology that underlies them. This may involve conventional testing as well as testing through functional medicine labs.
Intestinal Barrier Dysfunction May Develop in Many Autoimmune Diseases
Intestinal Barrier Dysfunction is a hallmark of autoimmunity. The immune system is housed in the gastrointestinal tract. When there is inflammation present, the lining of the intestine becomes damaged and becomes leaky. This allows larger molecules of food and toxins to enter the bloodstream, become systemic and travel to extra-intestinal areas of the body. These areas include the joints, skin and other organs.
All autoimmune conditions have the common denominator of intestinal permeability. In this condition, abnormally high levels of zonulin are present. This protein regulates the permeability of the tight junctions of the intestinal barrier. Once the gut is permeable, immune responses to foods can occur.
In this study published in 2014, researchers worked with experimental autoimmune encephalomyelitis (EAE), which is the prototypic animal model of MS in mice.
At the onset of the disease, they found intestinal permeability, increased zonulin and alterations in the mucosal layers of the intestines. Significantly, they found this in a disease of the brain. The researchers concluded,
Our findings show that disruption of intestinal homeostasis is an early and immune-mediated event in EAE. We propose that this intestinal dysfunction may act to support disease progression, and thus represent a potential therapeutic target in MS. In particular, an increased understanding of the regulation of tight junctions at the blood-brain barrier and in the intestinal wall may be crucial for design of future innovative therapies.
Perhaps this concept of intestine involvement can be generalized to many of the other autoimmune diseases – in fact it is.
Today in the research labs they are looking at auto-antibodies. By testing these antibodies they can predict what diseases a person may get years ahead of the expression of the disease. Hopefully in the next 10 years this kind of testing will be more available and used clinically.
Through the science of epi-genetics we know that environmental influences will affect the expression of genes. This may lead us to develop a way to prevent this expression.
Leaky Gut is Implicated in Celiac and All Autoimmune Diseases
In February 2012 in the journal, Clinical Reviews in Allergy and Immunology a paper called Leaky gut and autoimmune diseases was published. The author, Alessio Fasano, M.D., had been researching this topic in relationship to celiac disease and gluten sensitivity. The review paper he wrote is focused on the role of impaired intestinal barrier function (leaky gut) on autoimmune pathogenesis. In short, he is trying to get to the real causes of autoimmunity.
In this paper, Dr. Fasano proposes a new theory that suggests that autoimmune disease is not only preventable, but also reversible. Amazing!
It involves a perfect storm of three conditions:
- Increased intestinal permeability (leaky gut)
- A genetic predisposition to autoimmunity
- An exposure to the environmental trigger (in this case gluten)
What this means is that people who have a leaky gut, as well as the genetics for celiac disease, can develop autoimmunity when they eat gluten. This will cause intestinal damage. The increased intestinal permeability that is part of the leaky gut, allows the environmental trigger (which in this case is gluten) to access the body and this triggers the genetic predisposition.
Conventional understanding of celiac included variable numbers 2 and 3, but instead of leaky gut, the third variable was the presence of circulating auto-antibodies to the enzyme tissue transglutaminase. Using these antibodies excludes many people who do not test positive for them – however, they may still have problems with gluten (gluten sensitivity).
Acknowledging that auto-antibodies are present does not explain why they are there. Fasano’s theory does explain this. Furthermore, it suggests that if you can cure the leaky gut, you can cure the autoimmune disease.
Routine Blood testing for Autoimmunity
Each condition also has their own set of blood markers used for the initial diagnosis in addition to these listed below that are used as maintenance markers.
- CBC w/Diff
- HAIc – sugar in blood stimulates immune cells to release inflammatory cytokines
- Insulin – fasting and 2 hour post prandial
- Homocysteine — shows how we are methylating –if it is high must look at MTHFR and other genetic snps
- CRP – is an inflammation marker
- Sedimentation rate – is an inflammation marker
- Iron Panel – check for anemia
- Vit D (25-OH vitamin D) – ideally levels over 50
- Thyroid antibodies and complete panel including T3, T4, TSH, and reverse T3
The environmental trigger is the third aspect of the autoimmunity perfect storm. Some of these are:
- Gluten – Testing for celiac disease overlooks a lot of the folks who are gluten sensitive – just eliminate gluten (and maybe all grains) if you have autoimmunity
- Food Sensitivities – IgG response is delayed and not traditionally performed by a medical allergist even though these are more common and inflammatory – IgE is for immediate allergy testing
- Nutrient deficiencies – Organic acids testing and RBC testing
- Stress and Hormone Imbalance – Organic acids testing – organic acids are urinary metabolytes – In cases of enzyme insufficiency certain metabolytes get kicked out into the urine and can be identified
- Dysbiosis – Use stool testing to identify some of the bacteria and yeast
- Infections – Use stool and blood testing
- Toxins – Hair analysis for heavy metals and xenobiotics, pesticides, etc.
Treatment Based in the 4R Approach
- Remove – gluten, dairy, egg, nuts and other potential allergens, as well as aspirin, NSAIDS
- Replace – support function in the digestive tract with enzymes and HCl if needed
- Reinoculate – the bowel with prebiotics and probiotics and a diet that includes resistant starch
- Repair – the gut mucosa with gelatin rich bone broths, L-glutamine and other nutrients
This approach attempts to uncover the actual cause and imbalances in each individual rather than simply putting a bandaid on the symptoms. Each individual has their own set of imbalances and this needs to be corrected in a specific and individual way. Using conventional medicines that suppress the symptoms may be necessary alongside the integrative functional approach while healing is going on.
More and more there are chiropractors, naturopaths and functional medicine doctors that take this approach. As always, never change your diet, medicines or supplements without involving your health care provider.