Autoimmune conditions occur when the immune system starts attacking the body’s own cells thinking they are abnormal or foreign. There are two general types of autoimmune diseases: those that affect specific organs, such as the pancreas (Type I diabetes), and those that affect tissues throughout the body, such as joints (rheumatoid arthritis). There are overlaps between autoimmune diseases and patients may have more than one autoimmune condition at the same time.
The immune system responds differently in the two types of autoimmune diseases. In organ-specific diseases, two types of antibodies bind to cells that have specific markers on their surfaces. Once the antibody has attached itself, chemicals and inflammatory proteins are released that bring in other immune cells to destroy the targeted cell. These cells then also produce chemicals that stimulate the inflammatory response. In tissue-specific diseases, the immune system produces antibodies that don’t attach to specific cells. Instead, these antibodies are bound up in complexes that travel in the blood. The cells responsible for removing these complexes get overloaded, and the antibody complexes get deposited in different tissues. These deposits then trigger the release of the chemicals and inflammatory proteins that bring in other immune cells. As these cells attempt to destroy the complex, the surrounding tissue is also damaged.
The immune system is a complex balance of different cells and signaling chemicals; these cells and chemicals are divided into different groups based on the types of functions they perform. Two of the major groupings of the immune system’s function are Th1 and Th2, named for the two types of T helper cells that are active. In a Th1 state, killer cells are activated to destroy abnormal (e.g. cancer) cells or cells infected with microorganisms (bacteria, viruses, and fungi). In a Th2 state, antibody-producing cells are stimulated, and antibodies are used to attack microorganisms still outside the body’s cells. The Th1 cells also stimulate the Th2 cells when they present proteins from the abnormal cells or microorganisms to the Th2 cells to stimulate antibody production for long-term immunity. In auto-immune conditions, both Th1 and Th2 cells play a role; the Th1 cells present proteins from the body cells to the Th2 cells, which stimulate the production of antibodies. In general, some conditions tend to be more of a Th1 dominant state (e.g., rheumatoid arthritis, multiple sclerosis, Type 1 diabetes) and some conditions tend to be more of a Th2 dominant state (ulcerative colitis, lupus, scleroderma). It is important to note however, that these are only general guidelines, the particular balance of Th1 and Th2 can vary greatly from patient to patient, and all immune conditions have some degree of Th1/Th2 imbalance.
I believe treating autoimmune conditions involves three major goals:
- Support the functioning of the specific cells/tissues affected;
- Rebalancing the immune system between the Th1 and Th2 states to reduce antibody production; and
- Reduce the risks of developing additional autoimmune conditions, cancers, or other complications.
Different autoimmune conditions will have different target cells that are affected. For example, in Hashimoto’s thyroiditis, the cells of the thyroid are destroyed while in Type I diabetes, the insulin-producing cells in the pancreas are destroyed. Therefore, different functional support would be needed for these two conditions.
Immune System Rebalance
The body produces many different chemicals to signal which type of immunity (Th1 or Th2) should be stimulated, and which chemicals are produced can be influenced by many dietary and lifestyle factors. The three most common factors that unbalance the immune system are faulty digestion, leading to absorption of partially digested and unusable proteins, which increases the antibody immune response; white sugar, which directly weakens the functioning of macrophages and natural killer cells, and weakens systemic resistance to all infections; and trans-fatty and omega-6 acids, found in most heated and processed vegetable oils (e.g., soybean, safflower, corn, sunflower, and canola oil) and foods. The trans-fatty acids weaken killer-T cell activity. Vegetable oils are acceptable IF they are cold or expeller pressed oils, and stored in the dark. Other factors to avoid include:
- chronic infections, Candida (yeast), Streptococcus thermophilus (commonly found in yogurt);
- asbestos, heavy metals, pesticides;
- tobacco, alcohol, dehydration;
- stress, negative emotions, steroids, hormone imbalances, chronic insomnia; and
- sedentary lifestyle as well as weight lifting or exercising to excess.
Some positive immune factors include:
- Omega-3 Fatty acids are found in all cold water fish, especially salmon, sardines, mackerel, halibut, and trout, with lesser amounts in dark-green leafy vegetables and sea vegetables and algae.
- Oleic acids are best found in cold or expeller pressed extra virgin olive oil. Secondary choices include hazelnut or filbert oil (or the whole nuts), green and ripe olives, and almonds. Coconut oil can be used alternately with the other beneficial oils, especially for cooking.
- Glutathione acts as an antioxidant and is essential for balancing the Th1 and Th2 immune states.
- A healthy balance of intestinal flora change the Th2-Th1 balance of the immune system to re-establish the normal immune tolerance, in other words, the immune system knows what to respond to (i.e., bacterial infection) and what not to respond to (i.e., food). Continued use of a probiotic is necessary because the entire surface of the upper intestines replaces itself every 72 hours and the colon replaces itself every 12 days. These new surfaces need to be recolonized because the bacteria are lost with the cell shedding; there will be a loss of colonization over time if there is no replenishing. There are different forms of probiotics and the most important factors are that the organisms are alive and are in the correct balance and amounts of the Bifidus and Lactobacillus bacteria. For example, much higher levels are needed after antibiotics because Lactobacillus and Bifidus are highly sensitive to broad-spectrum antibiotics. Antibiotics can eliminate 90% of these beneficial flora, allowing pathogenic bacteria, parasites, and yeast to increase. Many probiotics also contain fructo-oligosaccharides (FOS), which is a soluble fiber. FOS can cause gas for some patients, which is an indicator of a bacterial imbalance in the intestines because pathogenic bacteria produce gas when they encounter FOS. Gas will decrease as the balance changes back to the beneficial bacterial types because Lactobacillus and Bifidus produce acid in the presence of FOS, not gas.
- Digestive enzymes break up proteins into usable amino acids. Apple cider vinegar stimulates hydrochloric acid, which is required to digest protein and activate enzymes. Eating slowly to allow natural salivary enzymes to work and eating only when hungry will also support good digestion. B vitamins are also required to support hydrochloric acid production and magnesium is required by the pancreas to produce enzymes to digest proteins. Both B vitamins and magnesium are also necessary for proper adrenal functioning. Chronic infections can also shift immunity toward Th2 and create an additional burden for the immune system, so investigating and treating chronic infections, especially in the digestive tract, is another key step.
- Sunlight, water, touch, positive attitude, and acupuncture also have a positive effect on immunity.
One dietary change I recommend for all autoimmune conditions is a gluten free diet. Gluten acts as a causative factor for celiac disease, so people with this diagnosis and/or a known gluten intolerance must avoid it. However, gluten also seems to increase immune activity for a wide range of other autoimmune conditions, and is best avoided as part of treatment for any autoimmune disease. Patients with auto-immune conditions should be cautious about adding supplements because many nutrients and herbs have multiple functions in the body. For example, green tea is considered to be very healthy as an antioxidant source, but it has also been shown to increase Th2 immunity. This might be a positive factor for a person with a Th1 dominant condition, but could worsen a person who already has a overactive Th2 immunity. Therefore, I evaluate immune function indicators very carefully and monitor reactions to different supplements closely to try to identify how the immune system is functioning for each patient and helping to rebalance the system accordingly.
The diagnosis of an autoimmune condition often carries with it additional risks of developing other immune disorders, primarily cancers of the affected cells or additional autoimmune conditions in other cells. For example, the risk of developing thyroid cancer or pernicious anemia, type I diabetes, or rheumatoid arthritis is higher for a person who has already been diagnosed with Hashimoto’s thyroiditis. This is one reason I believe that simply supporting individual organ function or providing symptom relief is not enough for autoimmune conditions. The immune system as a whole must be treated. Additionally, supporting a balanced immune state will also allow the body to detect and destroy cancer cells more easily and is therefore, beneficial for cancer prevention.