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What is an Autoimmune Disease?

    • The immune system is an amazing defense strategy for our healthy body. It quietly stands ready to protect us from outside invaders – bacteria, viruses, pollens, even our own cancer cells – swooping in to destroy them before they can harm us.

      But in an autoimmune disorder, that same immune system “turns on us” and begins to attack otherwise healthy cells in the body. This view of an autoimmune disease captures a wide variety of conditions that some may not think of as autoimmune conditions. Among the 80+ defined autoimmune diseases that impact the human body are:

      • Rheumatoid arthritis (the joints)
      • Multiple sclerosis (brain and nervous system)
      • Type 1 diabetes (pancreas and digestive system)
      • Grave’s disease (thyroid)
      • Hashimoto’s thyroiditis (thyroid)
      • Celiac disease (intestines)
      • Crohn’s disease (intestines)
      • Psoriasis (skin)
      • Lupus (multiple organs)

      According to Palo Alto rheumatologist Victoria Kelly, M.D., of Palo Alto Medical FoundationOpens new window this is just a short list of the many ways that an autoimmune disorder can show up in the body. “Sometimes the disease impacts just one organ, like the thyroid, or one area of the body, like the joints in rheumatoid arthritis,” notes Dr. Kelly. “In other cases, such as lupus, the condition can impact a wide variety of organs.”

      Many autoimmune diseases, such as MS, Graves’ disease and rheumatoid arthritis, appear in women more than men, and often strike younger women in their childbearing years. Autoimmune diseases don’t necessarily follow a predictable path. They can come and go, with years of quiet punctuated by “flares” when symptoms return.

      Because the appearance of an autoimmune disease can vary so widely, it is hard to generalize about patients’ prognoses. However, according to Dr. Kelly, most patients can live active, normal lives, if they follow treatment plans. Since young women are so often impacted, it is important to note that most women can go on to have healthy pregnancies, but need to work with their doctors about which medications are safe in pregnancy.

    • Why does the immune system overreact?

    • Doctors don’t understand precisely why the immune system goes awry, leading to such havoc in the body. What does seem clear so far is that some people may be genetically predisposed to getting an autoimmune disease – that is, if a family member has an autoimmune disorder, it’s more likely you could develop one. The interesting fact, however, is that it may not be the same disease. For example, if rheumatoid arthritis runs in the family, you might come down with psoriasis or some other autoimmune disorder.

      According to Dr. Kelly, there is also usually a trigger that starts the overreaction of the immune system. This may be a viral or bacterial infection, or another exposure, that starts the immune system response. Once started, it can move into overdrive and start attacking healthy cells.

    • Is autoimmune disease on the rise?

    • The number of diagnoses does seem to be increasing, but there may be disagreement on the cause of that. “Patients and physicians may be more aware of the disease and therefore able to make more accurate diagnoses,” says Dr. Kelly.

      Sacramento internist Maxine Barish, M.D., of Sutter Medical Foundation,Opens new window devotes her practice to holistic and functional medicine. Dr. Barish says there are huge increases in the diagnosis of certain autoimmune diseases since the 1950s, leading her and others to conclude that some environmental factor may be triggering more cases of immune system over-reaction.

      However, with no single database related to all forms of autoimmune diseases, looking for a common cause is difficult.

      One area receiving wide attention is diet – more specifically the increased sensitivity to gluten, which is found in certain grains such as wheat and barley, as well as multiple processed foods. Other foods like eggs, dairy products, and shellfish may trigger reactions in some people as well. Scientists are looking at a condition that has been called “leaky gut syndrome.” The theory of leaky gut syndrome is that the lining of the intestines becomes inflamed and permeable, allowing our body to absorb molecules we weren’t meant to absorb into the bloodstream; these molecules may then incite an inflammatory response in the body, leading to the production of auto-antibodies. It is speculated that multiple things may trigger leaky gut, including exposure to gluten, as well as processed flours and sugars, environmental toxins, and stress.

    • The diagnosis of autoimmune disease

    • Because of the range of diseases caused by an over-reactive immune system, it may be hard for patients and physicians to establish a diagnosis. Some single organ diseases present with clear symptoms, such as Type 1 diabetes in children or young adults. Other conditions, such as lupus, can present with a variety of symptoms, some vague and overlapping with other diseases. Diagnosis is usually made via blood tests and a careful evaluation of clinical signs and symptoms.

      “We are getting better at diagnosing,” says Dr. Kelly. “The number of antibodies that we have discovered in the past decade has increased dramatically, allowing us to detect via the bloodstream what we could only suspect from clinical symptoms before.”

      Another tricky complication is that some people can have these antibodies in the bloodstream, but not be experiencing any clinical symptoms. Among those with symptoms, they can range from mild to life threatening.

      Dr. Kelly suggests that if a patient has ongoing symptoms but has not received a clear diagnosis, it may be time to see the appropriate specialist in the field related to your symptoms (for example, a gastroenterologist for digestive symptoms or a rheumatologist for painful joints).

    • Treating autoimmune diseases

    • Standard treatment for autoimmune diseases involves medications that relieve symptoms and those that suppress the immune system response. “We often use the same type of drugs used in chemotherapy for cancer, but in much lower doses,” says Dr. Kelly. Future approaches will involve targeted therapies that impact molecules involved in the specific immune system response of each disease.

      Both doctors agree that patients can also improve their situation with healthy behaviors that include:

      • Rest and stress reduction. Activities like meditation, yoga or other stress reduction approaches can help calm the body. (For those with pain-based conditions, try this 5 step mindfulness practice for chronic pain developed by Dr. Barrish’s colleagues at Sutter Health’s Center for Integrative Health.Opens new window Others may want to explore a mindfulness based stress reduction program commonly referred to as MBSR.
      • Exercise. While extreme fatigue and joint pain may be a feature of some autoimmune diseases, exercise is still valuable, in whatever amounts the patient can tolerate. A great place to start is this yoga routine for relaxation.
      • Diet. Dr. Kelly notes that the Mediterranean diet provides a good balance of healthy ingredients. It also removes excess sugar, high fructose corn syrup and refined carbohydrates that may contribute to inflammatory responses in the body. Dr. Barish concurs that improving your diet can help. She recommends nutrient dense whole foods, and avoiding most commercially produced foods.
      • An elimination diet – removing foods like gluten, dairy or soy for weeks, and then slowly reintroducing one at a time, can help you discover foods that might trigger symptoms in the gut. Those suspecting a gluten sensitivity may try this gluten free diet plan. If lactose is a suspected problem, review the lactose intolerance survival guide for calcium sources and meal ideas.

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