Autoimmunity, autoimmune disease, Hashimoto's, thyroiditis, lupus, systemic lupus erythematosis, SLE, rheumatoid arthritis, dermatomyositis, scleroderma, multiple sclerosis, Crohn's disease, ulcerative colitis

Autoimmune Disease: We Have Met the Enemy and He is Us

Autoimmune Disease: We Have Met the Enemy and He is Us

© 2010 Dr. Dale Peterson &

The comic strip Pogo created by Walt Kelly featured animal characters in the Okefenokee Swamp. It ran in newspapers from 1948 to 1975. The protagonist was Pogo Possum, a sort of “everyman” who doled out bits of wisdom and thinly veiled political commentary to friends like Albert Alligator and Porky Pine.

Pogo’s most famous and enduring quote is, “We have met the enemy and he is us.” It first appeared on a poster created for Earth Day in 1970 and was repeated in the comic strip that appeared on Earth Day in 1971. Although Walt Kelly used the statement to point out the environmental damage caused by thoughtless littering, it is an apt description of what is called autoimmune disease.

Autoimmune diseases are extremely common. The National Institutes of Health estimates that 23.5 million Americans have at least one autoimmune disease. Others place the figure even higher, stating that autoimmune diseases afflict approximately 50 million people in the United States. Those figures represent 10 - 20 % of the population; one in every five to ten people. Roughly 75 % of those affected are women, making autoimmune disease one of the leading health challenges in the female population. Surprisingly, autoimmune disease is rarely mentioned as a women’s health issue.

To put this incidence of autoimmune disease into perspective one should consider that cancer affects up to 9 million people and heart disease up to 22 million. The economic impact of autoimmune disease is also greater than that of many other diseases. Authorities from the National Institutes of Health estimate the annual direct health care costs for autoimmune disease to be in the range of $100 billion, which is nearly double the $57 billion costs associated with cancer care.

To understand autoimmune disease one must begin with the concept of autoimmunity. A normal, healthy body is equipped with elaborate tools with which to defend itself from invaders such as viruses, bacteria, and parasites. These tools make up the immune system. Some of the tools are specialized cells such as monocytes, macrophages, dendritic cells, granulocytes, and lymphocytes. Others are specialized proteins, which include antibodies, acute phase reactants, and cytokines.

Antibodies are proteins that detect and destroy invaders or substances foreign to the body. Acute phase reactants circulate in the blood stream to help limit tissue injury, improve resistance to infection, and reduce inflammation. Cytokines regulate the magnitude of the response to an immune challenge.

Autoimmunity is defined as a condition in which the immune system attacks the body itself. Autoimmunity is present to some extent in everyone. In most cases it is harmless and its existence causes no symptoms or adverse effects. Under normal conditions, cells that attack body tissues are suppressed. When this natural suppression of autoimmune activity is lost, autoimmunity increases to a degree that symptoms appear. At that point one has passed from a normal condition of benign autoimmunity to an autoimmune disease state.

The exact mechanism by which autoimmune disease develops is unclear, but it is believed that two factors must be present. The first is a genetic predisposition to develop an autoimmune disease. This will not cause an autoimmune disease in and of itself, but if a second, environmental factor is present an autoimmune disease may emerge. Some environment factors suspected of triggering an autoimmune response are infections, exposure to toxic chemicals, and use of certain medications. Over 100 drugs have been implicated in the development of conditions such as systemic lupus erythematosis (commonly referred to simply as “lupus”) and autoimmune hemolytic anemia (a condition in which red blood cells are being attacked and destroyed). For most drugs the risk is considered low (less than 1 %), but for some, such as hydralazine and minocycline, the incidence of autoimmune disease may approach 20 % if they are used continuously for two or more years.

Autoimmune diseases may affect a single organ or they may affect the entire body. Examples of organ specific diseases include Hashimoto's thyroiditis (thyroid gland), pernicious anemia (stomach), Addison's disease (adrenal glands), and type 1 diabetes(pancreas). Some that affect the entire body are systemic lupus erythematosis, rheumatoid arthritis, scleroderma, and dermatomyositis.

The concept of autoimmune disease was not accepted by mainstream medicine until the mid-twentieth century. Prior to that time it was believed that the presence of enhanced autoimmunity was a consequence of the appearance of a disease process rather than a cause of that illness. Today, three types of evidence are used to determine that a disease is due to an immune system attack on the body. They are classified as direct, indirect, and circumstantial.

Direct evidence that a disease is due to autoimmunity requires that disease to be transferrable from person to person or from humans to animals. Autoimmune diseases that meet direct criteria include idiopathic thrombocytopenic purpura (ITP), Grave’s disease, myasthenia gravis, pernicious anemia, pemphigus vulgaris, and bullous pemphigoid.

ITP is a condition in which platelets are destroyed leading to spontaneous bruising. Human experiments in the 1950s showed that the platelets were being destroyed by autoantibodies that would continue to destroy platelets if administered to another person. Signs of Grave’s disease, an overactive thyroid condition, and myasthenia gravis, characterized by weakness, appear temporarily in infants born to mothers with those conditions. Pernicious anemia, in which the body is unable to absorb vitamin B12, has been shown to be due to autoantibodies to a chemical called intrinsic factor that is needed for the absorption of vitamin B12. The skin diseases, pemphigus and pemphigoid, can be transferred to animals by injection of autoantibodies.

Indirect evidence requires that the human disease be duplicated in an animal model. The majority of diseases classified as having an autoimmune origin fall into this category. Examples are systemic lupus erythematosis, Crohn’s diease, ulcerative colitis, Hashimoto’s thyroiditis, and multiple sclerosis.

Circumstantial evidence that a disease has an autoimmune etiology is derived from the presence of clues that suggest an autoimmune disease may be present. Clues include a family history of autoimmune diseases, a personal history of other autoimmune diseases, the presence of immune system cells in the affected tissue, high levels of autoantibodies in the bloodstream, the presence of antibody/antigen complexes in the affected tissue, and an improvement in symptoms with the use of drugs that suppress the immune system.

Since autoimmune disease can affect any part of the body, it can present with almost any symptom. Symptoms due to autoimmune disease often come and go and change over time. This makes the diagnosis of an autoimmune process difficult. If a physician does not immediately recognize what is causing a person’s symptoms that individual should begin documenting what is being experienced day to day in a journal or diary. It is often not a particular sign or symptom that defines the onset of an autoimmune disease but rather the progression or combination of symptoms over time.

Recognition and treatment of autoimmune disease is often delayed because of the manner in which medical care is typically delivered. When medical specialties began to emerge around the turn of the twentieth century they did so primarily by concentrating on specific body organs or structures. Cardiologists focused on the heart, ophthalmologists on the eye, gastroenterologists on the digestive tract, and rheumatologists on muscles and joints. There is remarkable little communication between medical specialties, and medical specialists rarely pay attention to patient complaints that fall outside of their particular spheres of interest.

Systemic lupus erythematosis is generally considered a disease treated by rheumatologists, but it may present not as joint inflammation, but as a facial rash. It may initially appear with numbness and tingling in the hands and feet or as a psychiatric illness complete with hallucinations. At other times it may show up as congestive heart failure or kidney failure. As a result, several different physicians may be treating the patient simultaneously without realizing that the various conditions have a common cause.

Even autoimmune diseases of affecting single organs often go unrecognized and untreated for extended periods of time. Thyroid autoantibodies resulting from Hashimoto’s thyroiditis can cause a person to experience symptoms such as weight gain, tiredness or feeling colder than others. These are commonly attributed to conditions such as depression, a sedentary lifestyle, or aging and appropriate treatment may be delayed for years if standard thyroid blood tests are normal, which they often are in the early and mid stages of the disease.

Autoimmune diseases are typically treated with non-steroidal anti-inflammatory drugs (NSAIDS) and corticosteroids, such as prednisone. If the disease is progressing, potent immune system suppressing drugs referred to as disease-modifying drugs are added. If the primary symptoms involve the musculoskeletal system these are called disease-modifying antirheumatic drugs (DMARDS). Disease-modifying drugs can produce devastating side effects; their use can have fatal consequences. Fortunately, much can be done to modify the course of autoimmune illness without resorting to the administration of highly toxic drugs.

The diet should be rich in fresh fruits and vegetables and generally free of refined carbohydrates (white rice and foods made from white sugar and flour). Packaged foods that contain additives and preservatives should be avoided. It is important to check for the presence of food allergies or sensitivities, as these can throw the immune system out of balance. Since the allergic response to foods may not be apparent for several days, the foods responsible are often difficult to identify. An elimination diet program, in which only basic foods are eaten for two weeks after which only one food is added at 3 – 4 day intervals, can be helpful in identifying foods that should be avoided. Blood tests looking for IgG antibodies can also provide clues concerning which foods should be removed from the diet. Fortunately, reactivity to foods lessens with time. If reactive foods are avoided for approximately six months, many people can add them back into their diet provided that they are not eaten more than twice a week.

Nutritional supplementation can play a key role in the management of autoimmune illness. Research has shown that vitamin D plays key roles in the operation of the body’s immune system. Several cells within the immune system contain receptors for vitamin D within their nuclei. An association between vitamin D deficiency and the progression of autoimmune disease has been found. Therefore, Vitamin D supplementation should be given for any autoimmune condition. It may be of particular benefit in diseases such as lupus and rheumatoid arthritis that appear to be influenced primarily by lymphocytes called B-cells, which contain vitamin D receptors.

Vitamin A has also been shown to play a crucial role in autoimmunity. In 2001, researchers from the Wistar Institute in Philadelphia discovered that immune cells called T-cells not only direct the fight against infection within the body, but are capable of suppressing the body’s immune response. Approximately 10 % of T cells are believed to be regulatory cells that play an important role in limiting the body’s attacks against itself.

Retinoic acid, a form of vitamin A in the body, stimulates the production of regulatory T cells. Therefore, supplementation of vitamin A may play an important role in preventing and suppressing autoimmunity.

It is highly doubtful that vitamins D and A are the only nutrients required to maintain a healthy immune system. Dr. Guy Abraham, who has done extensive iodine research, has proposed that autoimmune thyroiditis is related to deficiencies in iodine and magnesium. Because so little is known about the nutritional basis of autoimmune disease I recommend that everyone take a comprehensive vitamin/mineral/amino acid supplement daily. I believe it is wise to allow the body to choose the nutrients it needs to function properly today rather than waiting until medical research identifies those nutrients at some point in the future.

One of the mechanisms by which autoimmune disease develops appears to be oxidative damage. Dr. Abraham believes that autoimmune thyroiditis occurs when adequate stores of iodine do not exist to support the activity of an enzyme, thyroid peroxidase (TPO), that is instrumental in the production of thyroid hormones. When iodine stores are depleted, TPO begins to act as a free radical, causing oxidative damage to surrounding molecules, which may be other TPO molecules or those of a substance called thyroglobulin (Tg). Because the oxidized molecules do not have a normal appearance, the body’s immune system forms antibodies against them. Those antibodies not only attack oxidized forms of TPO and Tg, but normal forms as well. To limit oxidative damage within the body I recommend that plant-based antioxidants such as grape seed extract or grape skin extract (resveratrol) be supplemented along with the basic antioxidant vitamins and minerals in the comprehensive support.

Inflammation plays a significant role in nearly all autoimmune diseases. The body requires omega-3 fatty acids to effectively manufacture anti-inflammatory substances. Fish oils containing the fatty acids EPA and DHA are the most efficient means of obtaining optimum amounts of these critical nutrients. The other supports that are helpful in reducing inflammation in the body are systemic enzymes. Enzymes break down protein fragments. In so doing, they greatly reduce the reaction of the immune system to those substances, lessening the potential for autoimmune activity. Supplementation is begun at a level of 6 capsules or tablets three times daily, at least one hour before or two hours after eating. The combination of fish oils and systemic enzymes can significantly decrease the need for NSAIDS, corticosteroids, and disease-modifying agents in those dealing with an autoimmune process.

Immune system stimulants, such as Echinacea, should be avoided as they have the potential to aggravate the autoimmune response that is taking place. There are, however, a number of supports that act as immune system modulators, calming down overactive aspects of the immune system while improving immune function when it is necessary to do so. One of these immune system modulators is colostrum, an immune-supporting fluid produced by milk-producing glands during the first 24 hours after an animal gives birth. This fluid, which is collected from dairy cattle, can be used effectively to support the human immune system. Two capsules twice daily is a typical amount to prevent health challenges, but since colostrum is a food it is perfectly safe to take higher amounts if a condition is causing symptoms. As many as 20 – 30 capsules daily may be used if needed.

Another immune system modulator is beta-glucan, which is extracted from mushrooms, baker’s yeast, or certain grains. Resveratrol, which is a grape skin extract, and curcumin, from turmeric suppress specific chemicals that are known to stimulate an autoimmune response. Acemannan, which is found in the leaves of the aloe vera plant, also acts as an immune system modulator. If using aloe vera for immune system modulation it is important to use a brand that lists its guaranteed polysaccharide content on the label.

When working with individuals with autoimmune challenges I find it beneficial to run a check of their body’s central computer, restoring programs that do not appear to be working properly to their normal setting. This generally does not produce a cure in itself, but it allows other measures to produce greater results. I am also able to use the technique to lower the body’s reactivity to foods and other substances to which it is over-reacting.

In some instances heavy mold exposure or antibiotic use has triggered an overgrowth of yeast or other organisms in the body. This can cause the immune system to go into overdrive and trigger an autoimmune response. When this has occurred, restoring a normal balance of organisms within the body can bring about a dramatic improvement in the autoimmune disease.

Going back to the basics of drinking pure water, eating real food, being physically active, avoiding exposure to toxic substances, and providing comprehensive nutritional support can go a long way toward preventing the appearance of autoimmune disease. When an autoimmune process is present, adding the measures discussed above can often bring the condition under control without the use of NSAIDS, corticosteroids, or highly toxic and dangerous disease-modifying drugs.

As I once more consider Pogo’s words I can’t help but wonder if they are more applicable to autoimmune disease than we might think. Could the food additives and preservatives, refined sugars and flours, and drugs with which we have been polluting ourselves be as damaging to our bodies as abandoned tires, bottles and cans are to Okefenokee Swamp? We have indeed met the enemy, and he is us.

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