Autoimmune Disease: The Invisible Epidemic
Undoubtedly, you know a few people with an autoimmune disease. A childhood friend with lupus, an aunt with Hashimoto’s, or a neighbor with multiple sclerosis. Individually, these diseases may seem relatively infrequent. But taken together, they add up. The National Institute of Health (NIH) estimates there are approximately 24 million people with autoimmune disease with an additional 8 million people testing positive for ANA (antinuclear antibodies). (These antibodies are a group of antibodies are used to screen for autoimmune disease, though they aren’t diagnostic for a specific autoimmune disease.) This 24-32 million people is potentially a low estimate. The American Autoimmune Related Disease Association (AARDA) estimates there are 50 million people living with autoimmune disease. But even at the lowest estimate of 24 million, this means autoimmune disease is as nearly as prevalent as heart disease which affects 25 million Americans per year. Amongst chronic disease, the two are outpaced only by diabetes/pre-diabetes which affects 100 million (or 1 in 3) Americans. That’s a pretty big deal! And costs a lot of money too. Back in 2001, before he became THE Dr. Anthony Fauci, Fauci as director of the National Institutes of Allergy and Infectious Diseases estimated that annual autoimmune disease treatment costs were greater than $100 billion, and they have surely grown since then.
So, what is autoimmune disease? Broadly, autoimmune disease occurs when the body starts to produce antibodies that attack and damage its own tissues instead of an infection. Thanks to COVID, most of us are now very aware of what antibodies are! There are at least 80 known autoimmune diseases and possibly over 100. Most autoimmune diseases have a clearly identified autoantibody or set of antibodies associated with them, while some are still considered “suspected” autoimmune disease as they share a lot of commonality with autoimmune disease but an autoantibody has not been identified. And yet another group of conditions are considered more “autoinflammatory” rather than autoimmune. This means the body’s immune system is attacking itself, but no specific antibody has been identified rather it is the innate (non-specific) arm of the immune system causing the attack.
Research and awareness for autoimmune disease is complicated by the fact that each autoimmune disease is usually treated according to the tissue or organ that is being attacked. Multiple sclerosis patients see a neurologist, Hashimoto’s and Type I diabetes patients see an endocrinologist, celiac and other inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease patients see a gastrointestinal specialist, etc. From a broad perspective, this means that fewer people are studying autoimmune disease as a whole. From a personal perspective, this means that while the specialist you see is probably excellent at solving problems with the organ in question, they may not have as much experience understanding and treating the symptoms due to chronic inflammation someone with autoimmune disease undoubtedly has to contend with. As an example, many people with Hashimoto’s may be “treated” for Hashimoto’s by taking thyroid medications and still suffer from joint pain, extreme fatigue, IBS, depression, and anxiety. The thyroid medication is necessary but insufficient.
Below is a list of some of the more common autoimmune diseases, roughly in order of prevalence.
• Rheumatoid arthritis
• Hashimoto’s Thyroiditis
• Celiac
• Grave’s disease
• Type I diabetes
• Vitiligo
• Rheumatic fever
• Pernicious Anemia/Atrophic Gastritis
• Alopecia areata
• Immune Thrombocytopenic Purpura
• Multiple sclerosis
• Lupus (systemic lupus erythematosus)
• And many more….
While anyone can get an autoimmune disease, there are some groups higher at risk than others. 80% of autoimmune disease sufferers are women. Prevalence by race varies by specific autoimmune disease. For example, blacks are much more likely to be diagnosed with lupus but much less likely to be diagnosed with celiac disease. Interestingly, the data also varies by region which is very intriguing and suggestive of environmental influence! Note that this particular study relies on already diagnosed cases, and diagnosis is a huge problem in autoimmune disease. Again, it varies by disease but it can take multiple years, doctors, and misdiagnoses to get a correct diagnosis. Even more frustrating, considerable percentages of patients are often told it is psychosomatic (“all in their head”) along the way, 26.6% in this study on psoriatic arthritis and 36.2% overall (and 40.8% amongst the female respondents!) in this study on ankylosing spondylitis.
There is no single cause for autoimmune disease. It is thought to be a combination of genetic susceptibility, triggers such as infections or environmental toxins, and diet and lifestyle. While there is not much you can do about your genetics, this is thought to account for only about 1/3 of your risk. Likewise, infections can be tough to avoid. There’s a wide variety of bacteria, viruses, and parasites that have been shown to increase the risk of autoimmune disease. A few like borrelia (the bacteria transmitted by ticks) and giardia (a parasite sometimes found in untreated water) can be avoided through safe practices but most are not like this, and it is mostly just bad luck if you happen to get one. Environmental toxins are also only partially in your control. While we can attempt to control what substances we use in our home and personal care products (and I support this fully!), our regulations for toxic chemicals are frankly terrible in this country so the exposure is nearly inescapable once the chemicals enter our soil, air, and groundwater. Furthermore, the burden is disproportionally borne by the people who live in (or adjacent to) communities that are also the homes to either manufacturing plants or waste sites that contain toxic chemicals or who work in occupations where exposure is part of the job. Systemic change is what is required here. One of the most powerful things you can do is to vote for representatives who support regulating these harmful substances and powerful industries. For my fellow Californians, the California Environmental Justice Alliance produces a terrific legislative scorecard and voting guide each year to help you understand the issues and look up how your representative voted. I was pleased to see that in 2020 my local reps did pretty well: Ben Allen received an A- and Richard Bloom received a B. Pay attention to those local elections!
There are a few other important risk factors (not necessarily causes) to keep in mind. One is simply already having an autoimmune disease. Multiple autoimmune syndrome (MAS) can occur in up to 25% of all autoimmune patients. So, if you have a diagnosed autoimmune condition you are at risk for getting another one. Another is having one of the Ehlers-Danlos Syndromes (EDS), a connective tissue disorder. There are multiple sub-types of EDS. Most types are genetic and rare, however the most prevalent type is hypermobile-EDS (hEDS) for which a genetic basis is not known. Hypermobile-EDS has been associated with a higher risk of rheumatic autoimmune conditions. Those with autoimmune disease and hEDS share a lot of the functional gastrointestinal and food intolerance issues which I discuss in much greater detail in a post co-written with Vernon Rowe, MD: “The Gut-Brain-Hypermobility Connection with Autoimmunity.” You can also learn more about Ehlers-Danlos at the Ehlers-Danlos Society webpage here.
And finally we come to diet and lifestyle both of which ARE in your control.* The diet and lifestyle guidelines in the Autoimmune Protocol (AIP) are all targeted at supporting the immune system and decreasing inflammation. The details of how that is accomplished is a topic for another day, given the length of this already lengthy blog post. But if you want to learn more now, please feel free to download my AIP Quickstart Guide here or schedule a 30 minute free call here to learn more about how it might apply to you.
*Given that I’m a health coach whose passion is to educate people about the best food choices for themselves individually, I feel surprisingly squeamish coming down too hard on individual responsibility. You are NOT at fault for your disease. There are a lot of structural problems that stack the deck against us (and some of us more than others, whether it’s food insecurity and access to healthy foods (separate but related issues), government subsidies that make processed food absurdly cheap in comparison to healthy food, or out of date government guidelines. But within these constraints, there are still a lot of things you can do as an individual than can help modify your disease. And this is not a zero sum game…if you have the resources to make diet and lifestyle changes, you may find yourself with more energy both for yourself and to become involved with some of these issues (or whatever issues you are passionate about, it certainly doesn’t need to be these). That was certainly the case with me…when my Hashimoto’s symptoms were at their peak, I had absolutely nothing left at the end of the day after barely managing my job and own family. With the energy and freedom from symptoms I’ve gained over the years from diet and lifestyle changes, and yes, also some conventional medicine, I can tackle a lot more!