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March 25, 2019

Case Studies
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Can We Predict Autoimmune Disease?

Clients who come to my clinic commonly have (or are at risk for) autoimmune diseases and it’s likely that you have a friend, family member or colleague who is affected by one. It’s estimated that about 2 million Canadians and 50 million Americans suffer from an autoimmune disease, and globally the incidence of them has been steadily rising over the last 30 years. Autoimmune diseases are chronic, painful, life-altering and even life-threatening. Is it possible for us to predict whether autoimmune diseases will occur and can we do anything to prevent them?

What Are Autoimmune Diseases?

An autoimmune disease occurs when the immune system attacks itself. It views healthy tissues as foreign and begins to destroy them. There are dozens of autoimmune diseases, but some of the most common are:

  • Systemic Lupus Erythematosus (SLE)
  • Type 1 diabetes
  • Multiple sclerosis
  • Rheumatoid arthritis
  • Celiac disease
  • Hashimoto’s thyroiditis
  • Crohn’s disease and colitis
  • Psoriasis
  • Sjögren’s syndrome
  • Graves’ disease

There are multiple factors that influence the development of autoimmune disease including genetics, environmental triggers and intestinal permeability, but we know that most don’t occur overnight. It can take years for an autoimmune disease to manifest and by the time we experience a symptom (or multiple symptoms), it’s likely that an imbalance has already been in the body for awhile.

The Phases of Autoimmunity

Evidence indicates that autoimmune diseases follow a series of phases, with the end stage being the diagnosis of a serious clinical disease. The phases of autoimmunity are:

  • Normal Immunity: This is the normal stage, where a person has no symptoms nor antibodies circulating throughout the body
  • Benign Autoimmunity: Lab results show some common antibodies that indicate autoimmune disease, but no symptoms are present
  • Pathogenic Autoimmunity: More threatening and aberrant antibodies are discovered, along with the onset of signs and symptoms
  • Clinical Illness: This is end-stage disease, the culmination of the previous phases and a confirmed diagnosis of autoimmunity

The early phases of the development of autoimmune disease are referred to as the prodromal period or prodromal stage. During the prodromal period some signs and symptoms are present that might indicate disease, but specific and severe symptoms haven’t occurred. It’s derived from the Greek word ‘prodromos’, meaning precursor.

Case Studies: Rheumatoid Arthritis and Systemic Lupus Erythematosus (SLE)

Let’s discuss a couple of autoimmune diseases and how specific antibodies may indicate if a full-blown disease will develop.

Systemic Lupus Erythematosus (SLE)

Antibodies are considered central to the development to lupus – scientists know they occur before and alongside a diagnosis. An interesting study showed exactly how SLE-specific antibodies began and progressed through the testing of frozen military blood samples, which are collected every year or so to ensure personnel are healthy for active duty.

Analysis of the samples showed that the progression and final diagnosis of SLE mimicked the phases of autoimmunity outlined above. When antibodies began to appear (the benign stage), they were Anti-Ro, anti-La, antiphospholipid, and antinuclear antibodies. These are commonly found in SLE patients and may lead to SLE, but they can also be non-specific and don’t necessarily mean disease is inevitable. When the samples showed what the researchers called “ominous autoantibodies” –  anti-double-stranded DNA, anti-Sm and anti–nuclear ribonucleoprotein antibodies, this indicated active disease and eventual diagnosis.

What’s important to note is that antibodies appeared as early as 9 years before diagnosis (the average was about 3 years prior), and of the 130 military patients who had SLE, 115 had at least one autoantibody before they were diagnosed.

The researchers concluded “Autoantibodies are typically present many years before the diagnosis of SLE. Furthermore, the appearance of autoantibodies in patients with SLE tends to follow a predictable course, with a progressive accumulation of specific autoantibodies before the onset of SLE, while patients are still asymptomatic.

Rheumatoid Arthritis (RA)

Rheumatoid arthritis is a painful and inflammatory joint disease. One of the biggest predictors of the development of RA is the presence of anti-citrullinated protein antibodies (ACPA). A review of RA data concluded that “the generation of ACPA is a highly specific phenomenon for RA and starts even years before disease onset, and their presence has a high positive predictive value for future development of RA.” The study authors noted that ACPA was often more predictive of full-blown disease than Rheumatoid Factor (RF), proteins that are associated with RA and Sjögren’s syndrome.

Similar to SLE, the development of RA follows the phases of autoimmunity: patient blood samples present as normal, then there are ACPA antibodies without symptoms, and then progression of clinical symptoms that lead to a diagnosis. And this isn’t limited to SLE and RA. We now have evidence that antibodies can precede many different autoimmune diseases up to twenty-five years!

Autoimmunity predictability

Predictive Autoimmunity: Antinuclear Antibodies

Antinuclear antibodies (ANA) are a group of antibodies that can indicate autoimmune diseases. They indicate the possibility of a number of autoimmune diseases, including SLE, RA, Sjögren’s syndrome,  idiopathic inflammatory myopathies (IIM) and systemic vasculitides (SV). These antibodies are non-specific – meaning that if they appear in a blood sample, doctors can’t predict exactly what autoimmune disease you may get (or if you get one at all), but they are a strong indicator that your body is attacking itself for some reason.

The authors of this study note that demand for ANA testing has increased in recent years because “Early detection of antinuclear antibodies (ANA) in asymptomatic subjects is useful to predict autoimmune diseases years before diagnosis.”

The demand isn’t surprising. If you had evidence that your body may develop an autoimmune disease, wouldn’t you want to do something to halt or reverse its progress?

A common response by medical doctors to a positive ANA without any other symptoms, is to not do anything. Because they can’t make a specific diagnosis, they are not able to choose a specific treatment. As a result, a patient with a positive ANA gets sent on their way, without addressing the underlying issue(s). In functional medicine, we view a positive ANA as a wake up call, and a perfect opportunity to be proactive.

How to Prevent Autoimmune Diseases

Genetics, environmental triggers or blood markers of autoimmune diseases don’t automatically mean that the disease will eventually present. There are many things we can do to support our health and reduce our risk of developing autoimmune diseases.

Eat Nutritious Foods

Since we eat several times a day, our diet is an important way we can address autoimmune diseases. Fill your plate with anti-inflammatory foods like dark leafy greens, berries, carrots, squashes, nuts and seeds, healthy snacks, and protein-rich foods like eggs, fish and if needed, protein powders.

Another crucial element to nutrition and autoimmunity is eliminating the foods that may cause harm such as white flour, refined sugars, salt, vegetable oils, and anything that contains an ingredient that you can’t pronounce.

Exercise

Exercise can help reduce inflammation, a hallmark of many autoimmune diseases. Regular exercise can also boost and modulate immunity, which essential for autoimmune disease prevention. The best exercise is the type that you will actually commit to on a regular basis – pick something you enjoy and incorporate it into your weekly schedule.

Avoid Toxins

The triggers that can influence the development of autoimmune diseases are called autogens. This term was coined by writer and researcher Donna Jackson Nakazawa, author of The Autoimmune Epidemic, to describe the potential triggers of autoimmune conditions. Autogens can include heavy metals, infections, alcohol and drugs, gluten or any food intolerances, stress, chemical food additives, environmental toxins or chemicals in the home (cleaning products, personal care products, furniture, laundry detergents, etc.). You can learn more about detoxification here.

Avoid Gluten

Gluten can stimulate the immune system and lead to intestinal permeability, or leaky gut, which further exacerbates inflammation and destroys immune system function. Evidence suggests thatthe autoimmune process can be arrested if the interplay between genes and environmental triggers is prevented by re-establishing intestinal barrier function.

Address Stealth Infections

Certain infections, like Klebsiella, can lead to the development of the autoimmune disease Ankylosing Spondylitis. Be aware of your body and don’t ignore symptoms of illness, and work toward having a healthy immune system on a regular basis.

Reduce Stress

Short-term stress can be beneficial, however long-term stress leads to a suppressed immune system and chronic inflammation, plus it increases our susceptibility to infections. Psychological stress is associated with the development or onset of autoimmune diseases and can exacerbate those with existing autoimmune conditions. Try meditation, deep breathing, journaling, being in nature, gentle yoga, being with loved ones or any other activity that makes you feel calm and restored.

While there are a number of elements we cannot control in the development of autoimmune diseases, we can do our very best to support our health through diet and lifestyle practices. These make an enormous impact and can be set in motion every single day!