Autoimmune diseases have increased dramatically in recent years. There are nearly 200 recognized autoimmune diseases and the incidence has quadrupled in the past 20 years. Now approximately one in three women and one in seven men will have one of the recognized autoimmune conditions in their lifetime. Almost all autoimmune conditions are chronic i.e. lifelong conditions. Autoimmune conditions are difficult to diagnose; one estimate is that a victim may see five different doctors before getting an appropriate diagnosis and treatment.
Autoimmune diseases may account for as much as half of all chronic diseases. It is estimated that as many as 50 million Americans may suffer from one of the autoimmune diseases, double the rate of heart disease and quadruple the rate of cancer. The cost in health care dollars for autoimmune diseases is similar to that for cancer and about 1/3 of the total cost for heart disease.
What causes autoimmune disease? Autoimmune disease is a result of a person’s body developing antibodies against their own proteins and organ tissues. Antibodies of course are a part the natural defenses against invading organisms. The body makes antibodies that initiate the process of neutralizing the foreign invader. In a healthy response the body distinguishes between self and foreign and only attacks foreign entities. In an autoimmune response, the body makes antibodies to its own tissues.
The process seems to be potentiated by inflammation. Individuals are increasingly exposed to the many new foods and other chemicals in the environment. Through genetic engineering for example new foods and constituents in foods are created quickly that individuals have not adapted to. There is obviously a tradeoff, i.e., genetic engineering is one of the tools that plant scientists have employed to keep food production ahead of a rapidly increasing population. But new food products as well as environmental chemicals may be perceived as foreign to the body, potentiating the immune system. And as autoimmune conditions tend to develop slowly over time, the link between an environmental trigger and the eventual disease may not be obvious.
Another factor may be chemical modification of the body’s proteins. An example may be glucose and fructose, the major sugars in circulating blood. Glucose levels have increased dramatically in recent years, in part due to professional recommendations to cut back on fat during the “cholesterol and heart disease” campaigns beginning in the 1980s. As food producers removed dietary fat, the replacement was commonly carbohydrates. And carbohydrates are digested to glucose and fructose in the blood circulation. High fructose corn syrup became the most economical sweetener, cheaper than table sugar. Cells don’t readily process fructose for energy as they do glucose, resulting in fructose circulating in the blood and eventually being converted to fat in the liver.
There has been a dramatic increase in obesity and the high circulating blood sugar associated with Type 2 Diabetes during a similar time frame as the increase in autoimmune diseases. The circulating carbohydrate molecules are highly reactive and can chemically modify proteins, possibly making them seem foreign to the immune system. An eventual consequence may be an autoimmune condition.
Another common contributing factor is gluten from wheat. The protein in gluten has similarities to the protein lining the intestinal surface. The consequence is that when wheat gluten gets into the blood circulation, antibodies may be made which can attack the intestinal barrier. A result can be so called “leaky gut”, which allows molecules that would normally be excluded by the intestinal barrier to get into the blood circulation. Wheat, one of the staple foods, has changed drastically in recent years, altered through plant breeding to have more protein. Also, the bread making process has changed. In traditional bread making the yeast causing the bread to rise consumed much of the offending gluten. Newer processes often use chemicals which preserve the gluten.
Other contributors to autoimmune disease are infections. With increasing population densities and modern capabilities for travel, infectious agents can spread widely faster. Global warming may also be a factor in enhancing the distribution of infectious agents. An example is Lyme Disease caused by the Borrelia bacteria spread by certain ticks, which has increased markedly in recent years.
Another factor may be the decreasing nutrient quality of foods. In our modern agricultural practices, crops are harvested and shipped off to remote markets. Each crop may deplete micronutrients from the soil. Major nutrients are returned in the form of fertilizers but micronutrients are often not replaced. In geologic timeframe micronutrients are replaced by volcanic activity, but in our short-term time frame this mode does not function. There is evidence that people living in areas with regular volcanic activity are healthier. Micronutrients are more likely to be replaced in foods raised by more traditional organic practices and can be obtained from supplements.
Finally, the correlation between childhood trauma and incidence of autoimmune illness has been documented such as in a study which showed an increased likelihood of hospitalization with a diagnosed autoimmune disease, decades into adulthood. This article references other recent biological studies which show impact of early life stress on subsequent inflammatory responses. The article describes among several proposed causal links:
“research on nervous, endocrine, and immune interactions has revealed that these systems are anatomically and functionally interconnected. Stressors, such as infections, toxins, and/or psychological trauma, stimulate the hypothalamic-pituitary-adrenal axis to release corticoid-releasing hormone…resulting in elevated systemic levels of corticosteroids, such as glucocorticoids. Acute stress initially may increase inflammation through acute-phase mediators …that are eventually downregulated by glucocorticoids thereby maintaining homeostasis. Chronic stress has the opposite effect and decreases glucocorticoid levels. A recent epidemiologic study confirmed the link between childhood abuse and long-term changes in immune response; in this longitudinal study, childhood abuse was associated with elevated CRP levels, white blood cell counts, and other markers of inflammation 20 years later.” (Dube, Fairweather, Pearson, Felitti, Anda, Croft, 2009)
Even though autoimmune diseases are much more common than heart disease and cancer, there has been much less research and many fewer dollars directed to improving diagnosis and treatment. A barrier has been that the manifestations are so varied depending on the protein and tissue targeted. Different organ effects are treated by different medical specialties, so the underlying common contributing factors don’t get the attention of the other major disease conditions.
This overview provides a context for the dramatic increases in autoimmune diseases which approximately parallels increase in obesity and diabetes, as well the contribution of childhood trauma and toxic stress. Diagnosis and treatment are much too complex for this overview but there are good resources available for more information on these topics. An excellent book is “The Paleo Approach, Reverse Autoimmune Disease and Heal Your Body” by Sarah Ballantine, PHD. The paleo diet approach is not for everyone; evidence is emerging that depending on genetic background people respond differently to the various diets so each individual needs to find the diet that works best for them. However, this book even though targeting the lay person gives an in-depth explanation of the causes, manifestations and treatment of autoimmune diseases and the specific dietary recommendations may work for some individuals.
Another good book is “The Autoimmune Solution” by Amy Myers. The book explains how to prevent and reverse inflammatory and autoimmune diseases. Both books are available on Amazon as well as many public libraries. The book reviewed previously in this newsletter, “Childhood Disrupted” by Donna Jackson Nakazawa is also an excellent source for understanding the link between childhood trauma and adult illness as well as suggestions potential treatment for these long term emotional and physical issues.
Shanta R. Dube, DeLisa Fairweather, William S. Pearson, Vincent J. Felitti, Robert F. Anda, Janet B. Croft. Psychosom Med. Author manuscript; available in PMC 2012 Apr 4. Published in final edited form as: Psychosom Med. 2009 Feb; 71(2): 243–250. Published online 2009 Feb 2. doi: 10.1097/PSY.0b013e3181907888