More than 24 million Americans are affected by at least one of the over 100 identified autoimmune diseases, and studies suggest the rates are increasing. A common marker of autoimmunity, the anti-nuclear antibody (ANA), which can be positive for years before the full expression of an autoimmune disease, increased from 11% of the population in 1988 to almost 16% in 2012.
While conventional therapies for autoimmune diseases can help to manage symptoms, they don’t often address the underlying factors of immune system function. As a result, patients with autoimmunity may experience treatment side effects, less than optimal disease outcomes, and continued disease progression. Autoimmune diseases are complex, so an integrative approach that combines conventional and complementary therapies is important for potentially improving quality of life and disease outcomes.
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What is Autoimmunity?
Before exploring how autoimmune diseases are managed, it’s important to understand the immune system and what autoimmunity is.
The purpose of the immune system is to protect your body from potentially harmful microbes (bacteria, viruses, parasites, and fungi), to neutralize environmental toxins, and to help protect against cellular changes that could lead to diseases like cancer. When the body comes into contact with an outside invader or it becomes aware of damaged cells, the immune system activates to address the issue. This is a life-saving process, and it pays to have a robust immune response in these instances.
People with autoimmunity have a robust immune system response, but the process is misguided. In addition to targeting an invader or damaged cells, the immune system also begins to see the body’s own healthy cells, tissues, and organs as foreign. The immune system begins to create autoantibodies that attack normal cells. When this process continues, it can lead to significant damage to the body and a reduced quality of life.
Symptoms of autoimmunity may include:
- Chronic fatigue
- Unexplained fever
- Muscle and joint pain and swelling
- Muscle weakness
- Skin problems
- Digestive distress
- Swollen lymph nodes
- Hair loss
- Difficulty concentrating
- Poor sleep
Common autoimmune diseases include inflammatory bowel disease, celiac disease, multiple sclerosis, rheumatoid arthritis, psoriasis and psoriatic arthritis, scleroderma, systemic lupus erythematosus, type 1 diabetes, and vasculitis.
Now let’s review the conventional approaches that are available for people who have been diagnosed with an autoimmune disease.
Conventional Therapies For Autoimmune Diseases
Once the diagnosis is made, conventional therapies often include prescription medications like anti-inflammatories and immunosuppressive or immunomodulatory drugs that help to manage inflammation and modulate the immune system.
Non-steroidal anti-inflammatory drugs (NSAIDs) help to manage pain and inflammation by blocking cyclooxygenase (COX) enzymes. There are two broad categories of NSAIDs: traditional, which block COX-1 and COX-2, and selective COX-2 inhibitors, which block COX-2. Both traditional NSAIDs and COX-2 inhibitors may increase the risk of cardiovascular issues like congestive heart failure and heart attack. Additionally, traditional NSAIDs can block platelet aggregation, resulting in uncontrolled bleeding. They can also affect the kidneys and significantly impact the gut by causing bleeding, gastric ulcers, and gastric perforation.
Glucocorticoids, or corticosteroids, bind to specific receptors to inhibit certain pathways associated with the expression of pro-inflammatory signaling molecules. They may also promote immune tolerance in certain autoimmune conditions. These drugs function to reduce pain and inflammation, but their side effects may include gastrointestinal (GI) ulcers and bleeding, increased infection risk, and effects on bone health.
Disease-modifying antirheumatic drugs (DMARDs) suppress the production of pro-inflammatory cytokines, but they also inhibit overactive immune system T and B cells to reduce the tissue and organ damage common in autoimmune diseases. DMARDs can cause GI-related side effects, retinopathy, myopathy, rashes, and infections.
Anti-TNF biologic drugs block TNF, a pro-inflammatory cytokine that’s central to the development of many inflammatory autoimmune conditions. However, up to 40% of autoimmune patients who take these drugs don’t respond. Side effects may include infections like pneumonia and tuberculosis, but anti-TNF biologics may also increase the likelihood that patients will develop another autoimmune disease.
Janus kinase inhibitors target the JAK-STAT signaling pathway, which is involved in immune-mediated responses. Side effects may include an increased risk of infections like herpes zoster and upper respiratory tract infections, abnormal liver function tests, and increased risk of anemia, lymphopenia, and neutropenia.
These conventional medications can provide needed symptom relief and may slow the progression of many autoimmune conditions. However, they may not effectively address the underlying factors of autoimmunity, so they don’t provide much in the way of disease reversal, and they can come with serious side effects when used long-term. This is where complementary therapies may offer additional support.
Complementary Therapies for Autoimmune Diseases
Understanding how autoimmune diseases develop will help you understand why complementary therapies can be helpful for people with autoimmunity.
While autoimmune diseases still aren’t well understood, it’s thought that there’s an interplay between genetic and environmental factors, but we now also know increased intestinal permeability is likely a contributing component. Genetics, environment, and increased intestinal permeability may contribute to a loss of self-tolerance, which can induce the inflammatory cascade and cellular changes seen in autoimmune conditions.
The small intestinal barrier functions to allow needed nutrients and fluid to enter the bloodstream, but it also serves as a failsafe to keep things like toxins, undigested food particles, and microbes from entering the systemic circulation. In autoimmunity, intestinal barrier function may be altered, a condition sometimes referred to as increased intestinal permeability or leaky gut.
Leaky gut has been found to be a common component of many autoimmune diseases. It occurs when the family of zonulin proteins is upregulated, either from microbial dysbiosis or gliadin (a common food protein). When zonulin is upregulated, the intestinal barrier becomes more permeable, so it’s less able to regulate what’s coming into the circulation. When microbes, toxins, and undigested food particles cross the leaky barrier, the immune system response may increase with T regulatory cells and pro-inflammatory cytokines, which further increase inflammation. Without addressing a leaky gut, this process may continue, leading to further inflammation and further cell and tissue changes.
Therapies that target increased intestinal permeability can help to manage the inflammatory burden and support immune system function, which may help reduce or manage autoimmune disease symptoms. Dietary patterns are a main driver of dysbiosis, inflammation, and leaky gut, so an anti-inflammatory diet can be a priority for anyone with an autoimmune disease.
Nutrition Therapy for Autoimmune Disease
An anti-inflammatory diet excludes ultra-processed foods, added sugars, sugar-sweetened beverages, inflammatory fats, refined grains, and alcohol. It focuses instead on anti-inflammatory foods like fruits, vegetables, beans, nuts, seeds, whole grains, herbs and spices, tea, fish, and healthy sources of fat. Food sensitivities can be a trigger for increased intestinal permeability, so the diet should be tailored to the individual. In cases where a general anti-inflammatory diet isn’t helpful, a more restrictive elimination diet like the autoimmune protocol diet may be more appropriate.
Supplements for Autoimmune Disease
Setting the foundation with an anti-inflammatory diet is extremely important, but there are several supplements that may be helpful when it comes to managing inflammation and supporting gut barrier function. Ginger may modulate the immune system and have anti-inflammatory effects similar to NSAIDs. Curcumin may help manage the expression of pro-inflammatory mediators and support gut health. Omega-3 fatty acids can support inflammation management and act as prebiotics for commensal gut bacteria. Vitamin D is an important player in regulating immune system function, and has been shown to support autoimmune symptoms. Probiotics may help to support intestinal barrier function, manage colon inflammation, and decrease the movement of lipopolysaccharides (LPS- bacterial endotoxins) from the gut to the rest of the body.
Lifestyle Management for Autoimmune Disease
Along with a wholesome meal plan and dietary supplements, lifestyle factors must not be overlooked when it comes to managing the symptoms and the physiological process of autoimmune disease. Sleep, stress, exercise, and acupuncture are all complementary therapies for people with autoimmune diseases that can have a significant impact on quality of life and the disease process itself.
Sleep
Lack of refreshing sleep can alter the way the immune system functions and is indeed a risk factor for autoimmune disease development. If sleep is poor, sleep disorders like sleep apnea should be ruled out, and patients should be educated on how to create a healthy sleep routine.
Stress Management
Chronic stress can alter hypothalamic-pituitary-adrenal (HPA) axis function, which leads to hormonal changes and the release of pro-inflammatory mediators. Chronic stress also increases systemic inflammation and gut dysbiosis, increasing the risk of increased intestinal permeability. A daily stress management technique like yoga, meditation, or deep breathing can help to manage inflammatory mediators, support immune system function, and shift the body into the “rest and digest” state.
Exercise
Exercise can help with stress management but has also been shown to support gut health. In addition, people with autoimmune diseases are often at greater risk of other chronic diseases, so a consistent exercise schedule is important for managing risk factors like high blood sugar and high blood pressure.
Acupuncture
Acupuncture may help to support immune system function by managing inflammation and reducing the physiological effects of stress.
Unlike many conventional treatments, nutrition, supplements, and lifestyle changes have very few, if any, side effects. Some patients may experience an increase in symptoms when starting an elimination-type diet, but this typically subsides very quickly. When adding dietary supplements, it’s important to monitor for signs and symptoms of intolerance and to realize that negative symptoms may be due to an excipient in the supplement and not necessarily the active component of the supplement itself.
Integrative Medicine Clinics for Autoimmune Disease
Integrative medicine clinics focus on treating the whole person, not just a disease or illness. Integrative providers in these environments are generally open-minded and balanced in their approach, and they’re willing to explore all the available options to achieve maximum benefit. This may mean using evidence-based conventional therapies, as well as other therapies that are considered to be alternative in nature, like diet, nutritional supplements, time in nature, exercise, sleep, acupuncture, and yoga. The patient and their practitioners work collaboratively to address mind, body, and spirit with the ultimate goal of optimal health and healing.
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Conventional Testing Vs. Functional Medicine Labs for Autoimmune Disease
Getting an accurate diagnosis is challenging for patients with autoimmune diseases, likely due to the fact that symptoms can be vague and can come and go. It may take an average of six different doctors over the course of 5 years to get an accurate autoimmune diagnosis..
Conventional Testing for Autoimmune Disease
There are several initial conventional labs that may be ordered when someone has autoimmune-type symptoms:
Anti-nuclear antibodies (ANA) do not positively rule in an autoimmune condition. They are indicative that autoantibodies may be present. If the ANA is positive, then other testing will likely be recommended.
C-reactive protein (CRP) is a protein that the liver sends out in response to inflammation. High levels of CRP indicate an inflammatory process and possible dysregulated immune system function.
The erythrocyte sedimentation rate (ESR) is used to monitor for inflammatory disease severity. A high level may indicate an immune-mediated disorder.
The rheumatoid factor (RF) can be used to help diagnose rheumatoid arthritis.
The comprehensive thyroid panel that includes TPO and Tg antibodies can help with the diagnosis of Hashimoto’s thyroiditis and Grave’s disease, which are autoimmune thyroid conditions.
Functional Medicine Testing for Autoimmune Disease
These tests can be helpful for screening, but they aren’t diagnostic in isolation. Integrative providers may use certain functional medicine labs to look for the underlying factors of an autoimmune disease. Here are some options:
Comprehensive Stool Test
Poor gut health may be common in those with autoimmunity. The GI-MAP with Zonulin from Diagnostic Solutions gives insight into gut microbiome imbalances and includes markers for digestion, absorption, inflammation, and immune system function. The zonulin test also provides information on the presence of increased intestinal permeability.
Food Sensitivity Testing
Food sensitivities can contribute to inflammation and increased intestinal permeability. The Array-10 Multiple Food Immune Reactivity Screen by Cyrex Laboratories evaluates the body’s immune response to 180 foods and food additives. By identifying food sensitivities, the meal plan can be tailored for optimal results.
Micronutrient Testing
Micronutrients play an integral role in critical bodily processes. Patients with autoimmune diseases are often nutrient-depleted, which can increase the risk of chronic inflammation and negative symptoms. The SpectraCell Micronutrient Test can provide insight into nutrient deficiencies, but it can also help providers learn how well patients are using certain micronutrients.
Genetic Testing
Since genetics plays an important role in the development of autoimmune diseases, learning about genetic risk can be helpful. The 3x4 Genetics Test + Blueprint Report can help practitioners understand their patient’s genetic makeup and which areas to focus on in the overall plan.
Multidisciplinary Care Teams for Autoimmune Disease
Since autoimmune diseases are complex and can impact both physical and mental health, having a team of providers can offer an advantage over using one conventional provider. This collaborative team approach targets each underlying factor in a specific patient, which may significantly improve the quality of life and the disease process.
A multidisciplinary team may include conventional physicians and naturopaths, chiropractors, psychotherapists, herbalists, traditional Chinese medicine practitioners, acupuncturists, personal trainers, registered dietitians, massage therapists, and culinary medicine specialists. Each of these providers can bring a unique perspective to support the whole person in their health journey.
Empowering Patients in Autoimmune Disease Management
Current medical treatment may not fully address the needs of patients with autoimmune diseases. While conventional medications may be necessary, especially for people with more severe symptoms, they can come with serious side effects when used on a long-term basis. It’s important for patients to understand the risks versus benefits of medication therapy.
Oftentimes, people with mild to moderate autoimmune symptoms can thrive without medications when they address underlying factors with natural therapies like diet, supplements, and lifestyle. Even patients with more severe cases may be able to reduce or manage the need for conventional medications when they take a root-cause treatment approach.
An integrative approach will personalize the treatment to the specific individual and allow the patient to be involved in the decision-making process to determine which therapies may be most beneficial. The National Institutes of Health National Center for Complementary and Integrative Health is an excellent resource for patients wanting to learn more about integrative approaches for autoimmunity.
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Summary
Autoimmune diseases are on the rise, but despite advances in conventional medicine, treatment options may offer less than optimal results and can carry serious side effects. The development of an autoimmune disease is a complex, individualized process, so effective treatment requires a personalized approach to addressing underlying factors. Increased intestinal permeability may be one common factor in autoimmune conditions, and addressing it can be accomplished with natural therapies like nutrition, supplements, and lifestyle.
By combining conventional therapies with complementary options that address underlying factors, it may be possible to manage the full expression of an autoimmune disease and/or help with disease management. Patients with autoimmune diseases may benefit greatly from an integrative medicine clinic, which offers a variety of practitioners to tailor therapeutic interventions. These clinics take a whole-person approach by addressing mind, body, and spirit, and patients are an integral part of the decision-making process.
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