15 Sep Shifting The Understanding Of Disease: Autoimmunity
Our immune system is the mechanism biological entities [such as human beings] use to differentiate or identify themselves from the environment. It establishes who we are biologically as an individual organism and identifies and rejects those organisms or substances which are not part of ourselves. We all know that if our body gets invaded by bacteria or viruses, our immune system recognizes these germs as outside invaders and mounts a response to get rid of them. Most often it is this mounted response the one that makes us feel “sick” such as when we get the flu. The immune system is not located in any particular organ but spread throughout our bodies. The best known “actors” of our immune system are the white blood cells. There are many other components of our immune system spread all over our bodies.
What is autoimmunity?
“Autoimmunity [also known as autoimmune disease] is understood as an abnormal response of the body against substances and tissues normally present in the body.” In other words, autoimmunity is the result of a misdirected immune system that causes one’s own immune system to attack the self. Well known examples of autoimmune diseases are illnesses such as rheumatoid arthritis, psoriasis, lupus, multiple sclerosis, celiac disease, Crohn’s disease, ulcerative colitis, endometriosis, temporal arteritis, or juvenile or type 1 diabetes to name a few. Detailed lists of known autoimmune diseases can be easily found in basic internet searches. In these diseases our immune system is identifying some part of ourselves as foreign and attacking it.
Some interesting facts about autoimmunity show that there are about 50 million Americans today estimated to be living and coping with some form of autoimmune disease. Of these 50 million, 75% of them are women. The Office of Research on Women’s Health at the National Institutes of Health has declared autoimmunity as a “Major Women’s Health Issue.” Among women up to 65 years of age, autoimmunity is listed in the top 10 causes of death. Women have an enhanced immune system as compared to men, with increased resistance to many types of infections but also more susceptible to autoimmunity. Evidence suggests that an evolutionary trade-off for the “benefits” of testosterone for men is a decrease in immunity.
Affected women are mostly young, at child-bearing age and when most healthy. Diagnosis tend to be most challenging since symptoms can be insidious, vary widely and affect multiple body systems at times with misleading symptoms.
The American Autoimmune Related Diseases Association (AARDA) is the only national nonprofit health agency dedicated to bringing focus to autoimmunity as a major cause of serious chronic diseases. The AARDA made public two very interesting and most revealing surveys regarding autoimmunity. One survey showed that it takes autoimmune disease patients an average of 4.6 years and almost 5 doctors to finally get a diagnosis of autoimmunity. This means that people that are sick with some form of autoimmune disease spend many years (an average of 4.6) trying to find out what is wrong with them, and see about 5 different doctors before they come across a savvy practitioner who will suspect and then find the cause of their disease. The other survey showed that 45% of patients with autoimmune diseases have been labelled as “chronic complainers” in the early stages of their illness.
An autoimmune process is considered the underlying cause of more than 100 serious chronic illnesses. The range of manifestations relating to autoimmunity involves almost every organ system and tissue, with similar symptoms crossing over from one disease label to another. Interestingly, in conventional medicine, because these diseases cross over the different medical specialties boundaries (rheumatology, endocrinology, hematology, neurology, cardiology, gastroenterology, dermatology, etc.) and because such specialties usually focus on singular diseases within their particular category or organ system; there has been virtually no general consensus on autoimmunity as the underlying cause, and on the understanding of autoimmunity as a basic and common disease mechanism. Autoimmunity remains among the most poorly understood and poorly recognized of any category of illnesses.
As such, it is well accepted and stated in the conventional medical establishment that “a better understanding of these diseases [autoimmune] is needed as well as better, more effective methods of diagnosis and treatment.”
The current accepted facts and consensus among the medical establishment and the public in general in relation to autoimmune diseases, are as follows:
- There is no clear awareness of autoimmunity as a basic disease mechanism in the medical community or in the general public.
- No one is sure what causes autoimmunity.
- Autoimmune diseases tend to run in families.
- Women are at a higher risk of developing autoimmunity.
- The hallmark of autoimmunity is inflammation.
- Characteristically autoimmune diseases present a wavering pattern with flare-ups and periods of remission.
- Stress is clearly recognized as a major trigger for flare-ups.
- Stress reduction strategies are commonly recommended strategies to address autoimmunity.
- The most commonly used approach in conventional medicine to the treatment of autoimmune diseases is non-specific immunosuppression.
The Components of Autoimmunity
The best formulated and most widely accepted theory about autoimmunity states that in general, for an autoimmune process to manifest, individuals will present a genetic tendency to develop autoimmune diseases coupled under the right conditions with an outside invader or insult such as a virus or bacteria, a drug or other chemical or environmental irritant.
So, this statement about autoimmunity has 3 components that require more detailed attention; a genetic predisposition, an outside triggering factor, and the link between these two: “under the right conditions.”
The first component is genetic predisposition. While a number of genes have been implicated or associated with autoimmunity, particularly genes related to the human major histocompatibility complex (HLA- the group of genes that determine our individual immunologic identity), no single autoimmune disease has been clearly linked to a particular gene or group of genes or is considered an inherited disease. However, both from epidemiologic studies and animal experiments, the genetic tendency to autoimmune diseases being inherited is a well-accepted fact.
2-Patented Medications, Infectious Agents and Toxins: The Triggers
The second component is that of an outside invader or insult as the event initiating the autoimmune process. To this end a number of such triggers have been identified including a considerable number of patented medications coming from the pharmaceutical industry associated with initiating diseases such as lupus, thrombocytopenia, hemolytic anemia, severe skin conditions and others. Also numerous infectious agents (viruses in particular) have been associated with autoimmune disorders. A classic example of this is the rheumatic fever that can follow a streptococcal infection (strep throat). Yet, in most cases of autoimmune diseases there is no clear evidence or widespread consensus of a particular environmental trigger.
3- The Right Conditions
The third and overall least acknowledged, addressed and understood component of this definition is “under the right conditions;” although in my opinion, this is the most significant one since it stands as a qualifier to the other two components for being the link (or conditioner) enabling either of these to become significant. Further along in this article I’ll discuss more about this last component.
The Conventional Approach – Immunosuppression
Characteristically the conventional medical approach, irrespective of the specialty or organ system involved, is quite straight forward and fairly basic. When overtly evident, any known triggering insult is removed. However unfortunately, in the majority of cases, there is no clearly identified trigger. Following this occasional first step, the conventional approach ubiquitously revolves around some form of anti-inflammatory therapy most commonly in the form of immunosuppression with synthetic analogs of glucocorticoid hormones, chemotherapeutic agents, or some other more novel immunosuppressive strategies, and the subsequent management of all the undesirable consequences of such approach that inevitably develop over time. Such approaches tend to be only a containment of the manifestations of the underlying process and biologically and financially very expensive. For the most part autoimmune diseases are considered in conventional medicine as incurable and requiring containment strategies for life.
Focusing on Immune Modulation
Contrary to this conventional approach, at the Tahoma Clinic we have developed over the years a much more comprehensive strategy to address autoimmune processes and in many instances obtain long term remissions with natural therapies mostly devoid of significant side effects, and at times even cures (or lifelong remissions).
As an initial part of this more comprehensive approach there is a much more developed awareness among our practitioners about autoimmunity as a possible underlying condition for complaints mentioned by our patients. For example, the symptom of fatigue alone may be enough to justify an autoimmune work-up.
When autoimmunity is suspected or evidenced through testing results the therapeutic approach focuses on immune modulation as opposed to suppression. This has three main pillars.
1- Food Allergies
The first step is to remove any insult, either known to be a causative trigger or a source of chronic inflammation. Food allergies or sensitivities are a common theme behind autoimmunity, possibly either as a causative factor or as a “primer” of the immune system being a source of chronic inflammation. Our gut is certainly the most immunologically active organ system in our body and together with our food they are most likely the “starters or perpetuators” of many chronic inflammatory states. Gut healing is a key step behind many “miraculous” and well documented cures; particularly in diseases associated with autoimmunity. Addressing chronic infections such as candidiasis (the overgrowth of a fungus called Candida Albicans) is sometimes part of this initial step also.
The second step in our approach has to do with cutting down inflammation with botanicals and other natural anti-inflammatory substances such as curcumin, resveratrol, ginger, and a plethora of other natural remedies. A commonly recommended supplement with excellent anti-inflammatory effects is Ultra InflamX by Metagenics. The cutting down on inflammation pares up with the removal of the inflammatory insult by cooling down the existing inflammatory process while preserving intact the other functions of the immune system. This process is part of the immune modulation approach, in essence leaving your immune system intact to do its job without over-reacting; the key difference between modulation and suppression.
The third part of our approach is that of rebalancing the immune system, also part of the modulation process. In this step optimization of the blood level of vitamin D is fundamental. Also hormones such as dehydroepiandrosterone (DHEA) and estriol (a type of estrogen) play a very important role in this rebalancing process. Optimizing their levels in the body is another key component to this step. Lastly, low dose naltrexone, a prescription only synthetic medication developed and used to counteract the effects of narcotics such as morphine, when used at low doses seems also to have a positive immune modulating effect and is favored by many natural medicine practitioners.
The Mind-Body Connection and The Future of Medicine
At our Tahoma Clinic Redmond in conjunction with a multidisciplinary group in the Eastside of which I am part, the Holistic Healing Circle (HHS for short), we are taking this protocol one step further, researching and developing one aspect of this natural and integrative approach to take it to a new level. Holistic medicine is about approaching the human being, health and disease not only as a malfunctioning biological machine but as a “whole” sentient and self-aware entity where the relationship with the self and the others, emotions and other aspects of the sentient self are as important (or maybe more) to our wellbeing as our genetics, or the food we eat, or the toxins or germs we are exposed to. Intra (to ourselves) and inter (to others) personal relationships are as much part of our exchange with the environment as air, water, food, germs and every other aspect of matter we interact with.
This approach radically departs from the ubiquitous dualism characteristic of today’s medicine (dualism = two parts – understanding the biological function of the body –the material part- as a separate and independent process from the inner workings of our mind, our thoughts and emotions, etc.; our biology and our psychology as two different and independent aspects of the self). Common in today’s exchange between doctors and patients, an individual finds him or herself passively witnessing a malfunction in their biological machine and taking it to a specialist (a mechanic of sorts) for him or her to fix it: “here Doctor, these are the keys to my body. Please call me when it’s fixed and let me know what I have to do to keep it running.” By the way, this approach is most convenient for the medical system since maintaining the individual disengaged, passive and dependent on the specialist is certainly most lucrative for the medical industry. Disease management and disempowered dependency on the system generate a lot of money for the medical industry while healing and empowerment are bad business strategies for this industry.
With all this said and understanding how I work at the Tahoma Clinic Redmond, now we can address the third component of the mechanism behind autoimmunity: “under the right conditions.”
In my experience, patients showing some form of autoimmunity, while having a genetic predisposition and having evidently come across some form of trigger that started the process; they carry with them a very significant and unaddressed emotional load. It is my working hypothesis at our clinic in Redmond that this unaddressed emotional load either constitutes or is a very significant part of the “right conditions” for autoimmunity to manifest. Using every available and valid tool to bring this into awareness and then, when ready, address it is a key component of our approach to autoimmunity at Tahoma Clinic Redmond. In those instances where people are ready and willing to go there, the successful resolution of autoimmune diseases is mounting up. Parallel to our experience, today scientific evidence is mounting to staggering levels in many different areas of human research showing an everyday more unquestionable mind-body connection; evidence that makes the dualistic understanding and dualistic approach of the human being scientifically obsolete. As obsolete as thinking of the Earth as flat after ships sailing west from Europe started returning back to Europe from their long trips around the world.
It is quite remarkable to think about an autoimmune disease as: “here I am at this point in my life where I find myself with my body having turned against itself. Here I am, witness to this remarkable, painful, uncomfortable, inconvenient and debilitating turn of events. I am, in fact, attacking myself.” The question is: “Am I really a passive witness to this turn of events?” or am I standing exactly where my feet took me through the sum of my choices and experiences?”
There are lots of tools available to start addressing this aspect of disease and autoimmunity should be regarded, among many other things, as a red flag about ourselves and about how we engage our reality. Or, as Gabor Maté, MD, the renowned holistic practitioner from Vancouver, Canada said: “When the body says no.”
Today, progress in medicine in my opinion is unquestionably linked to the deepening of our understanding of the human being as a whole, to the development of a practical integrative approach to the person and all of his/her aspects as one continuum. Remaining stuck in the idea that my psychology has nothing to do with my biology will only help perpetuate the model of disease management so deeply entrenched in our healthcare system and amply proven to be unsustainable. Holism and Integration is the Future of Medicine.
Gaston Cornu-Labat, MD is a holistic physician and surgeon, and medical director of the Tahoma Clinic Redmond, part of Dr. Wright’s Tahoma Clinic in Seattle, Washington.
Dr. Gaston focuses on natural pain treatment with no drugs or surgeries, and in the development of an integrative and holistic model for biological optimization and the treatment of chronic diseases with the use of cost-effective and evidence-based modalities. Find out more at www.tahomaclinicredmond.com or by calling 425-497-9558