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THE SPECTRUM OF AUTOIMMUNITY
In this chapter, we're going to talk about where disease comes from. Here's a question for you: Do think that you wake up one morning with a disease like diabetes or Alzheimer's or an extra 30 £ds? No. Scientists tell us these are results from decades-long processes that develop in a step-by- step sequence. But if you gain the big-picture view of the disease sequence, it becomes clear that there is a way to "nip it in the bud"--or, as scientists say, arrest the development of autoimmune disease--and stay healthy longer and with a shorter period of disability at the end of life.
My work in the world of celiac disease and wheat sensitivity has made me one of the leading experts in this field. Because celiac disease is the one autoimmune disease that has clearly been mapped--what makes you vulnerable (genetics), what's the trigger (gluten in wheat, rye, and barley), and what's the "last straw" before it begins (intestinal permeability)--it is a good model to study. I'm going to refer to it throughout this chapter, as well as the rest of the book, as a classic example of the autoimmune spectrum.
A spectrum is used to classify an idea or object in terms of its position on a scale between two extreme or opposite points. The spectrum of autoimmunity is a progressive state of disease that runs from vibrant health at one end to degenerative disease at the other. In between lies a broad range of varied but related stages that build on each other, usually moving in the direction of more disease. This is how we suffer from autoimmune damage long before we're diagnosed with autoimmune disease and long before the first symptoms occur. Again, on one end of the spectrum, there are no obvious symptoms: This is referred to as benign autoimmunity. On the other end is a well-defined health problem: disease or clinical illness. The in-between area of the spectrum holds the disease process (the accumulation of damage), which is referred to as pathogenic autoimmunity. The benefit of understanding this spectrum is so we can consciously shift our direction away from disease and back to vibrant health. That is the purpose of this book.
This health deterioration can be measured in terms of its intensity by the level of antibodies. When there is a slight elevation of antibodies, some people may have noticeable symptoms, while others with tremendously high levels of antibodies may have no symptoms at all. Yet both types of people are on the spectrum, and they will progress along the spectrum until they are diagnosed with a chronic or deadly disease. This is why it does not matter whether you notice symptoms or not: If you have elevated antibodies, they are fueling tissue degeneration.
Whenever we are exposed to any environmental trigger (such as gluten, peanuts, mold . . .), our immune system is activated to protect us. This is happening 24/7, and it's designed to work in the background so we don't notice it. This is referred to as normal immunity: You feel nothing. If the level of insult (the amount of exposure) increases, you might experience some kind of mild irritation, like a runny nose, sore muscles, or brain fog. If the level of exposure continues to increase, the immune system has to respond more aggressively, which begins the inflammatory cascade. Excess inflammation beyond the normal range will cause cellular damage. Continued cellular damage will cause tissue damage. Continued tissue damage will cause organ inflammation. Continued organ inflammation will increase the intensity of symptoms, and you develop elevated antibodies to that organ. Continued elevated antibodies to an organ leads to organ damage. Now you have symptoms that can be identified as an autoimmune disease.
This mechanism is the primary pathway in the development of autoimmune disease, opposite.
In 2003, Melissa Arbuckle, MD, PhD, and her colleagues published a landmark study in the New England Journal of Medicine that chronicled the autoimmune disease spectrum. Dr. Arbuckle investigated the patient history of 130 veterans in the VA hospital system who had been diagnosed with lupus, a classic autoimmune disease that affects skin, joints, and organs.1 During their years of active duty, all servicemen and women have their blood drawn many times. Luckily for Dr. Arbuckle's team, the US government has been freezing and saving blood samples since 1978. She asked for permission to examine frozen blood samples taken when the current lupus patients were healthy and serving in the Armed Forces.
Her study showed that every single veteran who had a positive diagnosis of lupus had markers for seven different elevated antibodies that caused lupus in their bloodwork years before they had any symptoms. The level of antibodies increased every year until they reached a plateau, at which point the organ damage was severe enough for symptoms to appear. This stage is called early pathogenic autoimmunity. By the time the patients reached this plateau, they were sick enough to see a doctor.
As time went by, more cells were attacked, inflammation increased, and symptoms became worse. Finally, when the symptoms were no longer tolerable, the servicemen and -women went to the doctor and were diagnosed with lupus. Yet each of the men and women in the study were on the autoimmune spectrum for lupus at least 5 years earlier. We can't feel when antibodies are killing off our cells in the earlier stages, so there is nothing to alert us to tissue damage until it progresses to the point where clinical illness is apparent.
If this were you, when would you want to know that you were on the spectrum of autoimmunity? Would you wait until you had enough organ damage to have noticeable symptoms, or would you try to catch disease before there is so much damage that the symptoms demand medical attention?
In the graph below, look at the seven different antibodies that can cause lupus. When the study participants first noticed symptoms of lupus, we see that just over 18 percent of those eventually diagnosed with lupus, technically referred to as systemic lupus erythematosus (SLE), had elevated anti-Sm antibodies 5 years beforehand; 28 percent had elevated anti-dsDNA antibodies; 48 percent had elevated ANA antibodies; 56 percent had elevated anti-La antibodies; 59 percent had elevated anti-Ro antibodies; and 64 percent had elevated aPL antibodies.
Similarly, when patients received the diagnosis of SLE, we see in the bottom graph that all seven antibodies were elevated more than 5 years beforehand. This is a critical concept to understand: The antibodies are elevated, thus damaging targeted tissue, years before there are noticeable symptoms or a diagnosis is made.
The severity of the symptoms depends on how long you have been on the autoimmune disease spectrum and how much tissue damage has accrued. The "gift" of having symptoms is that it will force you to take notice and do something to address a problem. It is the window of opportunity to do something about these often seemingly unconnected symptoms before there is so much tissue damage one gets a disease. Your recurring symptoms like fatigue, bloating, lack of energy, and memory lapses, or seemingly unrelated symptoms that come out of nowhere, might be messengers from your immune system letting you know that something's out of balance.
Yet let's be clear: Symptoms are not the first manifestation of a problem; they're the last straw when your body cannot compensate further. While your body has been working very hard compensating for your tissue damage and trying to maintain balance, its abilities to "adapt" by compensating to maintain balance (a process known as allostasis) are worn out. Now the accumulating damage begins producing symptoms. Once that ball starts rolling, unless you stop it, the problem only gets bigger and bigger.
Oddly, chronic health conditions are almost accepted as normal parts of life: fatigue, pain, depression, obesity, insomnia, anxiety, headaches, and many more. These symptoms may be common, but they are not normal. The difference is huge: Common means a lot of people have it; normal means "that's the way it's supposed to be." The "common" symptoms (being sick, fat, tired, and forgetful) should not be accepted as "normal," and knowing this should be empowering enough for all of us to say to our doctors, "Wait a minute, is what I'm experiencing common or normal?" The truth is, no one should have to live with symptoms, no one should accept them, and no one should ignore them.
The worst thing that you can do is neglect your symptoms or habitually take pain relievers to deal with them. While there's nothing wrong with occasionlly taking aspirin, ibuprofen, or other nonsteroidal anti- inflammatories (referred to as NSAIDs), or even prescription pain relievers every once in a while, when you are taking them regularly, you've exposed yourself to a new problem. Up to 65 percent of people who take NSAIDs for 6 months or longer develop inflammation in the intestines, which can lead to arthritis in any joint in your body.2 The NSAIDs can cause a secondary autoimmune reaction that I call collateral damage, which you'll learn about later.
The second problem with relying on pain relievers is that you never address the underlying issue that is causing the pain. Imagine that you are driving a car and a light appears on your dashboard. Would you pull over and reach underneath the dashboard, look for the wire that's connected to the warning light, cut the wire, and then head back on the road and continue driving? My guess is no. We know better than that--our cars won't last long and might put us in danger if we ignore the warning light. Do you think your body is any different? Yet we do something similar to our bodies when we take pain relievers without looking for the underlying trigger for the pain.
Neglecting or suppressing symptoms allows the underlying imbalance to continue causing more tissue damage. While it's perfectly normal and expected to want to feel better right away, we need to address the mechanism causing the discomfort or the degeneration will continue to the point where medications will no longer address the symptoms. For example, while antibiotics can effectively treat acne, they bring only short-term relief and don't address the root cause of the problem. What's more, taking them comes with many long-term consequences, such as damage to bones, scarring, and autoimmune hepatitis.3
LOOK AT BLOODWORK CAREFULLY
When your doctor reviews results of a blood test with you, and there is an H or L next to a blood marker, signifying high or low, and the doctor tells you that your results "are normal," ask the doctor this question: "Doctor, is it common or is it normal?" This one question will possibly open up a line of communication as to why this number is high or low, because it is certainly not normal.
If you want vibrant health, you have to decipher what your body is trying to tell you. The truth is, the body's language never lies; we just have to learn how to understand what our body is saying. That's the whole goal of this book: to teach you how to listen to your body and ask it the right questions. Once you understand the basics of how your immune system gets activated to protect you from perceived threats, and learn its language, you can find the trigger or root cause of your symptoms and identify which offending invader put you on the autoimmune spectrum. Next, you can identify where you are on the spectrum, which opens a window of opportunity to address the underlying mechanism years before enough tissue damage has accrued, symptoms begin, and a diagnosable disease has occurred. Then you can reverse the trend and roll back the ball to optimal health through simple lifestyle changes.
KNOW YOUR IMMUNE SYSTEM
The vast majority of us are moving toward the dangerous, far end of the autoimmune spectrum as a consequence of our immune system trying to protect us from the increased exposures of a toxic environment. The goal is to move all of us toward the other end of the spectrum, back to normal immunity. The first step is to get the big picture of how the immune system works.
Your immune system acts like the armed forces--it's there to protect you and is composed of different branches that work together. There is a metaphorical army, navy, air force, marines, and coast guard (which are referred to by doctors as the antibodies IgA, IgG, IgE, IgM, and IgD, but more on that later), each of which has a distinct role that protects us and allows us to survive and thrive on the planet.
There are actually four different immune systems in the body, and each can produce the five types of autoimmune responses listed above. The largest one is found in the gastrointestinal tract (the gut), where 70 to 85 percent of your immunity resides. There is another immune system in the liver called the Kupffer cells. The third comprises the white blood cells found in the bloodstream. Finally, there's one in the brain made of glia cells.
Each of these systems operates separately, but all follow the same owner's manual and communicate with each other. Each immune system is constructed of at least two arms: the cellular, or innate immune system, which acts as the protective handguns firing chemical bullets, and the humoral, or adaptive immune system, which is the heavy artillery that's called in when you need backup.
When faced with an invader, whether it is made of cancer cells, bacteria, viruses, parasites, offensive dietary proteins and peptides, or even chemicals such as medications, the innate/cellular arms produce cytokines, the biochemical bullets I refer to as the first responders. These cytokines recognize and then destroy whatever they consider threatening. A number of different types of cytokines are produced, and the immune system determines which one to launch depending on the threat. For example, we support the immune system through vaccinations, and we receive separate immunizations for measles and mumps; each time, we are targeting a different cytokine. If the cellular arms' defensive strategy cannot get the job done, the immune system calls up the "big guns." This is when the humoral/adaptive immune system kicks in, and its soldiers launch targeted missiles called antibodies.
This complex biological system works 24/7, and its limited arsenal is all we have to protect our internal health from the outside world. The immune system has to work very hard in today's world, and it can become overtaxed easily. Sometimes, offending invaders slip through the cracks and trigger (1) infections or (2) the nagging symptoms that you may be putting up with that do not progress into a diagnosable infection. Either response can progress into major diseases. This is particularly true for children and the elderly, as the immune system takes time to fully mature and often wears down as we get older.
