Introduction to autoimmune disease: What is it? How common is it? How is it diagnosed? How is it managed?

Main points of this issue:

  • Rates of autoimmune (AI) diseases are increasing every year in the U.S.
  • The diagnosis of AI disease is only made after there is degeneration of tissue
  • Most AI cases remain undiagnosed
  • Most AI cases continue to progress over time
  • Most AI patients develop more than one AI disease during their lifetime
  • Conventional healthcare has very little to offer these patients besides steroids

Autoimmune Disease in the U.S.
One of the things we know for sure is that the rates of autoimmune (AI) disease in the U.S. continue to go up for all AI diseases. There is an explosion of AI disease happening now like never before.

Autoimmune diseases are the third leading cause of morbidity and mortality in the industrialized world, surpassed only by cancer and heart disease.1

While many individual autoimmune diseases are rare, collectively they are thought to affect approximately 8 percent of the United States population  24 million persons.

To provide a context to evaluate the impact of autoimmune diseases, cancer affected approximately 9 million people and heart disease affected approximately 22 million people in the United States.2

What is Autoimmune Disease?
Autoimmune disease occurs when the immune system begins targeting self-tissue causing destruction of that tissue or organ. There are many different AI diseases that have been identified, such as rheumatoid arthritis (RA), multiple sclerosis (MS), lupus (SLE), Hashimotos thyroiditis, Crohns disease, ulcerative colitis (UC), type I diabetes and Celiac disease (CD).

AI disease can affect every organ and tissue in the body
Autoimmune diseases can affect virtually every site in the body

At least 15 diseases are known to be the direct result of an autoimmune response, and circumstantial evidence links more than 80 conditions to autoimmunity. 3

AI disease is usually progressive over time
There is no cure for most AI diseases. AI patients generally suffer more and more symptoms of tissue destruction over time. Conventional treatment is focused on suppressing the immune response and controlling symptoms but little is offered to the patient in regards to modulating the autoimmunity and avoiding triggers that cause flare-ups of the autoimmune response. As a result, AI conditions tend to cause more and more tissue destruction over time, eventually leading to severe tissue destruction and organ failure in many cases.

Diagnosis of AI Disease
The diagnosis of AI disease is only made after there is degeneration of the tissue In conventional healthcare, the diagnosis of AI disease is based on destruction of tissue (observable on diagnostic imaging), along with autoantibodies (antibodies against self-tissue) and other markers found in the blood along with clinical findings (signs and symptoms of patient). However, the development of tissue destruction or organ failure does not happen overnight. What about the 5-10 years of suffering the patient had before they are diagnosed with the disease?

AI Reaction vs. AI Disease
During the early stages of autoimmunity, the immune system is attacking tissue and initiating an AI reaction (based on the presence of antibodies) but the diagnosis of AI disease is not given until observable destruction of tissue has been identified. An AI reaction is when the immune system starts to attack self-tissue. The presence of autoantibodies indicates that the immune system is initiating an immune response against self-tissue (tissue or cellular components of the body). During an AI reaction, you may or may not have symptoms of that tissue being destroyed. Symptoms will only occur when the tissue destruction is severe enough to lead to a change in physiologic function.

The AI reaction isnt really a concern in the conventional model
Our current healthcare system typically waits until the patient shows evidence of tissue destruction before they are given the diagnosis of autoimmune disease. For example, you may have autoantibodies against the cartilage and swelling and pain against your joints, but it isnt diagnosed as rheumatoid arthritis (RA) until destruction of joints have been seen on X-ray or MRI. Or you may have myelin antibodies but you will not be given the diagnosis of multiple sclerosis (MS) until there are observable changes or lesions in the MRI of the brain or spinal cord.

Most AI disease remains undiagnosed.
Collectively autoimmune diseases have been identified in about 24 million people in the U.S., and only 1/3 are diagnosed. That means about 72 million people have an AI disease. Its not looked for. Our system waits until the signs and symptoms are severe enough with organ failure and irreversible damage before we identify it. 4

Prevalence of Multiple Autoimmune Diseases
The other thing we know is that when people have antibodies against one known tissue type, there is likely other antibodies against other tissue as well. In other words, when a person is diagnosed with AI disease, they are at high risk of developing other autoimmune diseases during their lifetime. It is very rare that only one tissue type is targeted by the immune system. When we look at people with AI disease, they may have multiple types of tissue being targeted that have not yet been identified. For example, the literature shows people with thyroid autoimmune disease have over a 50% chance of being affected by another autoimmune disease.5

Conventional treatment of AI Disease: Immune-suppressing medication
People with AI reactions usually dont get diagnosed and dont get any management or support until they get diagnosed with AI disease in conventional medicine. Once patients suffer sufficient tissue destruction to be diagnosed with AI disease, what does conventional healthcare have to offer? The standard of care is steroids and other immune-suppressing drugs. Steroids are usually not used in the initial stages because the adverse and damaging effects on the body make it not worth the risks. Some of the side effects of steroids include: immune suppression, bone loss, neurodegeneration, insulin-related issues, epithelial thinning, catabolic states so they cannot recover, etc. So patients arent given steroids until their condition has become severe and progressed. If the tissue destruction is severe enough, doctors may use a bone marrow-suppressing drug to shut down the immune system completely or they may take out the thymus in some of the more severe conditions such as myasthenia gravis. There really is little hope in the conventional model of healthcare for these AI patients to have an impact on the progression of their autoimmunity since the focus of treatment is suppression of the immune system. These immuno-suppressive agents come with significant adverse effects.

Alternative Treatment for Autoimmune Disease Not Much Better
Many of these patients end up seeing an alternative healthcare practitioner. What happens then? If the practitioner doesnt know its an AI reaction, they treat every symptom separately. For example, a person comes in with parietal cell antibodies, cartilage antibodies, myelin antibodies and skin epithelial antibodies and all the symptoms characteristic of each of these diseases. What would be the treatment? Most likely, the alternative practitioner would offer different treatments for each of the symptoms with no consciousness that they really only have one underlying mechanism, which is autoimmunity. They would not consider focusing treatment on the immune system. Nor would they consider focusing on finding the triggers of the autoimmunity. In addition, with many autoimmune people, you cant just give them any type of treatment because some compounds will actually flare up their autoimmunity. Many of the supplements these patients are already taking are flaring them up and making them worse because they are triggering their AI mechanisms. When you look at alternative medicine, they oversimplify autoimmunity to be due to either nutritional deficiencies or caused by heavy metals, viruses or parasites. This is a very simplistic way of looking at autoimmunity. There is more to autoimmunity than just piling on supplements, hunting for viruses and parasites and eliminating metals.

Heavy metal chelation is not a good idea for many of these patients, either. Sometimes doing heavy metal chelation can flare these people up and get them to a place they can never get out of. Alternative practitioners cant just randomly do these types of therapies because it is not efficient patient management and can actually flare these patients up to a critical condition.

Functional Medicine: A Better Option for Autoimmune Disease

Autoimmune Regulation as a Therapeutic Approach
When you look at the dysregulation of the immune system that occurs in autoimmunity, we know that there are different systems involved in the targeting of tissue for destruction. Autoimmunity is a multi-variant process and the goal should be to calm down the autoimmunity, specifically the immune response against self-tissue. There are several innate regulating systems of immune function that begin to dysregulate in autoimmunity. In functional medicine, we attempt to modulate the autoimmunity by regulating these various systems.

When we consider treatment of autoimmunity, there are 3 things we focus on:
1. Finding the triggers causing the autoimmunity to flare up and remove them
2. Modulating the autoimmunity and decrease the tissue destruction
3. Enhancing and supporting their recovery from these flare-ups

We are not talking about curing these AI conditions because we dont know how to do that. But we can make it so a person has more good days than bad days.

In future articles in this series on autoimmunity, we will be discussing in more detail what these systems are and how we can intervene with dietary changes and nutritional medicine to modulate immune function.

The Journal of Immunology, 2005, 175: 41194126.
NIH. Autoimmune Diseases Coordinating Comm. Autoimmune Diseases Research Plan. 2006
Jeffrey S. Bland, Ph.D.; Metagenics Educational Programs. 2006
ACTA BIO MEDICA 2003; 74; 9-33