Living With Chronic Pain

Autoimmune Disorders

Life is hectic. Between taking care of children, family members, spending time with friends, and managing a career, we all tend to feel tired and achy. But, are these symptoms of a stressful life, or an underlying condition like an autoimmune disease?

Our body’s immune system is set up to protect us from disease and infection. When an autoimmune disease occurs, our immune system starts attacking healthy cells by mistake.

According to the National Institute of Health (NIH), the etiology of autoimmune diseases is unclear but they tend to run in families. More women are affected then men, and African-American, Hispanic-American, and Native-American women have the highest risk. A person’s genes, in combination with infections, and other environmental exposures are likely to play a significant role in disease development. More than 80 diseases occur as a result of the immune system attacking the body’s own organs, tissues, and cells. Many have similar symptoms. Often, the first signs are fatigue, muscle aches and a low fever. The classic sign of an autoimmune disease is inflammation, which can cause redness, heat, pain, and swelling. These diseases tend to have flare-ups when they get worse, and remissions, when symptoms get better. This can make determining the diagnosis difficult.

There’s been a stark rise in autoimmune disorders such as type 1 diabetes, systemic lupus erythematous, rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis, Hashimoto’s thyroid disease, celiac disease, and asthma over the past 50 years. More than 23 million Americans suffer from autoimmunity, which makes it the third most common category of illness in the United States after cancer and heart disease.

The National Institute of Health (NIH) currently labels more than 90 diseases as autoimmune disorders, and that number is certain to rise as scientists continue to identify and further understand the origin of other diseases. Type 1 diabetes for example, was only recently found to be autoimmune driven. Unlike the type 2 we’ve been discussing in past posts.

Ana-Maria Orbai, MD, M.H.S, a rheumatologist at the Johns Hopkins Arthtitis Center, states the most common autoimmune diseases include:

• Rheumatoid arthritis:

This is the most common type of autoimmune arthritis. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

• Psoriasis:

This a common skin condition that speeds up the life cycle of skin cells. It causes cells to build up rapidly on the surface of the skin. The extra skin cells form scales and red patches that are itchy and sometimes painful. Psoriasis is a chronic disease that often comes and goes.

• Psoriatic arthritis:

About 30 percent of people with psoriasis also develop a form of inflammatory arthritis affecting the joints.

• Lupus:

A disease that damages areas of the body that include joints, skin, and organs, it occurs 90% of the time in women. The American College of Rheumatology states only about 11 – 13% of persons with a positive ANA test have lupus, and up to 15% of completely healthy people have a positive ANA test. Thus, a positive ANA test does not automatically translate into a diagnosis of lupus or any autoimmune or connective tissue disease.

• Thyroid diseases:

This includes Graves’ disease, where the body makes too much thyroid hormone (hyperthyroidism), and Hashimoto’s thyroiditis, where it doesn’t make enough (hypothyroidism) of the hormone.

Symptoms of autoimmune disease may be severe in some people and mild in others. “There are different degrees of autoimmune disease,” says Orbai. “The symptoms a person gets likely relate to multiple factors that include genetics, environment and personal.” Despite the varying types of autoimmune disease, many of them share similar symptoms including:

• Fatigue

• Joint pain and swelling

• Skin problems

• Abdominal pain or digestive issues

• Recurring fever

• Swollen glands

Diagnosis can be difficult because these symptoms also occur in other common conditions. If you’ve been healthy and suddenly feel fatigued or have joint stiffness speak to your healthcare provider. A thorough history, exam, lab, and X-rays can help to either identify or rule out an autoimmune disorder. Treatments are available for many autoimmune diseases, but cures have yet to be discovered. The first step toward a cure is understanding and controlling the causes. Researchers don’t know exactly what those causes are yet, but several theories point to an overactive immune system attacking the body after an infection or injury. We do know that certain risk factors increase the chances of developing autoimmune disorders, including:

• Genetics: Certain disorders such as lupus and multiple sclerosis (MS) tend to run in families. “Having a relative with autoimmune disease increases your risk, but it doesn’t mean you will develop a disease for certain,” says Orbai.

• Weight: Being overweight or obese raises your risk of developing rheumatoid arthritis or psoriatic arthritis. This could be because more weight puts greater stress on the joints or because fat tissue makes substances that encourage inflammation.

• Smoking: Research has linked smoking to a number of autoimmune diseases, including lupus, rheumatoid arthritis, hyperthyroidism and MS.

• Certain medications: Some blood pressure medicines, antibiotics, and cholesterol lowering agents can trigger episodes. Before starting or stopping any medications, however, make sure to talk to your doctor.

One of the top experts in the field is Alessio Fasano, MD, the director of the Center for Celiac Research & Treatment at Massachusetts General Hospital for Children in Boston. Decades of research led him to deduce that every autoimmune disease has three basic ingredients: a genetic predisposition, an environmental trigger, and a leaky gut. Identifying the first two components is easy. Scientists have long known that autoimmunity runs in families and that onset of some diseases can be triggered by an environmental factor such as an infection. But it wasn’t until 2000 that Fasano and his team discovered the third and final ingredient — a leaky gut. Specifically zonulin, a protein that regulates gut permeability. “Zonulin works like the traffic cop of our bodies’ tissues,” he says. “It opens the spaces between cells, allowing some substances to pass through while keeping harmful substances out.” Some people produce excess amounts of zonulin, which pries apart the cells of the intestinal lining and allows toxins, bacteria, and undigested bits of food into the bloodstream — hence the term “leaky gut.”

The gut’s slick, slimy insides, if spliced and laid flat, would carpet a tennis court. The uppermost lining is a mere one cell thick and is home to trillions of bacteria. In a healthy gut, the good bacteria outnumber the bad. But keeping a healthy ratio is tough. Years of eating junk food, popping pain relievers, and experiencing stress, inflames the gut’s lining. Everyone’s gut can spring a leak from time to time. A leak can form after an infection, a virus, or gastric upset. Some people have symptoms, like bloating, gas, or indigestion. If the gut is healthy, the lining will heal. But if the gut is in bad shape, it may not be able to close the fissures. Inside a leaky gut, zonulin opens the door for bacteria, viruses, fungi, parasites, chemicals, and pollutants to enter the bloodstream. Confronted with a steady stream of invaders, the immune system makes T-helper cells, which speeds up the leak. Substances produced by T-cells can irritate and inflame the body and indirectly activate genes capable of triggering autoimmunity.

A healthy diet creates a healthy gut and protects your body from autoimmunity. Here are some helpful hints in maintaining a healthy digestive system:

Eat a wide range of plant-based foods: 

A healthy gut has a diverse community of microbes, each of which prefer different foods.

Eat more fiber:

Most people eat less than they should. Fruit, vegetables, pulses, nuts, and wholegrains feed healthy bacteria. But a sudden increase can cause bloating. This is less likely if you make gradual changes and drink extra water.

Avoid highly processed foods: 

They often contain ingredients that either suppress ‘good’ bacteria or increase ‘bad’ bacteria. Eat more whole, unprocessed foods like vegetables, beans, nuts, seeds, and whole grains

Choose extra-virgin olive oil over other fats when you can:

It contains the highest number of microbe-friendly polyphenols.

Antibiotics kill the bad bacteria along with the good:

If you need antibiotics, make sure you eat lots of foods that boost your microbes afterwards.

Pinpoint food allergies:

For two weeks, cut out gluten, dairy, yeast, corn, soy, eggs, and other highly allergenic foods, and see how you feel.

Eat good fats: 

Studies show omega-3s protect against autoimmunity by reducing inflammation and helping heal a leaky gut.

Reseed your inner ecosystem:

Consume prebiotic and probiotic-rich foods, like plain yogurt, sauerkraut, kimchi, kefir, etc.

Plug any leaks: 

Gut-healing nutrients, like glutamine and zinc, help repair the gut’s lining so that no more nasties can slip through.

If you’re concerned you may have an autoimmune disease, don’t be afraid to talk to your healthcare provider about all your concerns. If diagnosed with an autoimmune disease, listen to your body, become aware of what triggers your symptoms and work with your healthcare provider to minimize them, maintain a healthy weight and mobilize.  With the proper regimen, life beyond the diagnosis does exist.

-Dr. Courtney

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