AUTOIMMUNE DISEASE: LUPUS, RHEUMATOID ARTHRITIS, MULTIPLE SCLEROSIS THYROID AND OTHERS…………………
Autoimmunity is the failure of an organism to recognize its own constituent parts as self which represent an immune response against its own self and tissues.
Any disease that results from such an aberrant immune response is termed and autoimmune disease.
It is important to review the spectrum of autoimmune diseases.
Organ-specific autoimmune diseases include Hashimoto’s thyroiditis, primary myxoedema, thyroid toxicosis, pernicious anemia, autoimmune atrophic gastritis, Addison’s disease, myasthenia gravis, pemphigoid, vitiligo, and the occasional lung and prostate autoimmunity.
Nonorgan-specific autoimmunity includes multiple sclerosis, autoimmune hemolytic anemia, primary biliary cirrhosis, active chronic hepatitis, ulcerative colitis, Sjogren’s syndrome, rheumatoid arthritis, dermatomyositis, scleroderma, mixed connective tissue diseases, discoid lupus erythematosus, and systemic lupus erythematosus.
Autoimmunity is multifactorial in nature.
There is evidence of initiating factors with secondary gene susceptibility as well as environmental factors.
Neuroendocrine and sex hormones also modulate the disease.
There is evidence of gut brain inflammation with mucosal immune abnormalities, imbalanced gut flora, intestinal barrier dysfunction, systemic inflammation, neural inflammation, neural invasion, and neural degeneration seen. Genes plus environmental factors are responsible for the development of autoimmune disease.
Women are far more likely than men to succumb to autoimmune disorders for probable reasons of estrogen.
There have also been studies noting mercury exposure causes immunologic changes and can cause autoimmune disease.
Studies have shown that exposure to methyl mercury reverts in serum autoantibodies suggesting that the assay of these autoantibodies against nervous system proteins may provide a means of assessing early neurotoxic effects have environmental methyl mercury exposure.
There is also a relationship between infectious agents also associated with autoimmune.
For example, Rubella, Rubeola, Epstein-Barr, retrovirus, influenza B, coxsackie virus and Yersinia are all associated with thyroid disease. Recently infections like Lyme, mycoplasma, and fungal infections might also be causative in these diseases. These probably represent molecular mimicry.
It is well known that in celiac disease autoantibodies are present. Immune response occurs with dietary protein gliadin which causes autism in children. When the barriers are broken down, the results will be food intolerance, immune disorders including immunity.
There is an initial intestinal barrier dysfunction resulting in food allergy intolerance and immune system abnormalities resulting in autoimmunity.
Emerging evidence has suggested that environmental factors such as occult dental infection seen in root canals, xenobiotics, and some dietary proteins and peptides result in the pathogenesis of many autoimmune diseases. They also occur from cross-reactivity of infectious agents.
At the present time, there are antibody arrays for the detection of autoimmune disorder, especially associated with gluten sensitivity and celiac disease.
To provide a context to evaluate the impact of autoimmune disease, cancer affects approximately 9 million people, and heart disease approximately 22 million people in the United States while 24 million people have autoimmune disorders. The problem is that only one-third are diagnosed. This means that about 72 million people have autoimmune disease, but it is not looked for.
There is increasing evidence for the involvement of heavy and transitional metals in various autoimmune diseases.
Chronic exposure to metals occurs through dental restoration, jewelry, hip and knee prostheses, foods or environmental pollution.
Cigarette smoke contains nickel, cadmium, manganese, mercury, lead and arsenic. The danger of heavy and transitional metal resides in their physiochemical properties that is binding to sulfur and other groups in the mitochondria, enzymes and cell proteins. Fat-containing organs such as the brain or collagen-containing structures rich in SH groups are vulnerable to metal bindings.
Metals induce free radical formation and active enzymes and mitochondrial activity and acts as a trigger in inflammation, allergy, and autoimmunity.
Metal-induced inflammation is frequent. Approximately 30% of the women in Europe and the U.S. suffer from nickel allergy.
In children and adolescents, allergies to organic mercury compound thimerosal is frequent, even surpassing nickel allergy. The reason is the wide use of this compound as a preservative for vaccines, pharmaceuticals, and cosmetics.
The diagnosis of metal allergy is usually performed by a blood test which examines the presence of memory T cells in the blood.
These memory T cells remember previous encounters with a particular foreign substance. Following recontact, they grow and divide. This process can be replicated outside the body in a MELISA test which stands for Memory Lymphocyte Immunostimulation Assay.
Other mentals found in dental alloys include gold, platinum, silver, palladium, iridium, indium, zinc, tin, gallium, titanium, chromium, cobalt, molybdenum, manganese, nickel, cadmium, beryllium, mercury, copper, and vanadium. Of course, there is corrosion with the saliva daily.
Heavy metal screening I feel is especially important in autoimmune disease. Since metals bind strongly to protein and are thus immunologically active, after they bind the sulfur group and change their configuration, they are recognized by the immune system as foreign and are attacked. This has been well documented in autoimmune as well as chronic fatigue subjects.
Increased reactivity to metals has been found in multiple sclerosis, chronic fatigue, rheumatoid arthritis, Crohn’s unexplained food allergies, fibromyalgia, ALS, lupus, autistic disorder, thyroid disease as well as cancer. Studies have shown that removal of dental amalgams decreases autoantibodies against the thyroid and autoimmune thyroiditis.
ACCURATE IDENTIFICATION OF THE GASTROINTESTINAL HEALTH IN SYSTEMIC AUTOIMMUNE DISEASE
There are over 400 species of microbes in the human intestinal tract totaling over 15 pounds, a mass that exceeds all other organs of the body other than skeletal muscle.
There are more microbes in the human intestinal tract than there are in the stars in the galaxy, exceeding all other cells in the body combined. Interesting facts also are that there are more than one hundred million nerve cells in the human small intestine roughly equaling that of the spinal cord. The gastrointestinal tract has every class of neurotransmitter contained in the brain.
Please note that the surface area of the human intestinal tract is approximately equal to that of a regulation single tennis court. I feel that the importance of mucosal immunity and mucosal integrity is of prime importance in autoimmune disease.
Using sophisticated testing, I perform markers of intestinal health, dysbiosis, and microbial metabolic byproducts. People who benefit by stool analysis include those with inflammatory bowel issues, skin condition, fatigue of unknown origin, change in bowel habits, and of course autoimmune disorders.
There is evidence in these diseases of intestinal hyperpermeability.
There has been epineurologic association between GI microbes and systemic autoimmune pathology. Klebsiella is seen in ankylosing spondylitis, Citrobacter and Klebsiella are seen in rheumatoid arthritis, Yersinia is seen in Graves’ and Hashimoto’s, and E. coli and Proteus are seen in other autoimmune disorders.
THE GUT AUTOIMMUNE CONNECTION
When there is evidence of maldigestion, leaky gut, and GI infection, a new complex is formed.
For example, the mucous membrane of healthy people is colonized by Bifidobacteria, Lactobacillus, Bacteroides, and Enterococci.
The mucous membrane in rheumatoid arthritis subjects is mainly colonized by aerobic opportunistic conventional pathogenic enterobacteria such as Escherichia coli, Citrobacter, Enterobacter, Klebsiella, etc., Staphylococci, Enterococci and anaerobic bacteria such as Peptococci.
Taking into account significant changes of colonization resistance in the colon mucosa membranes in the remission period of RA, it may be necessary to apply bacterial therapy using bacterial drugs containing Bifidobacteria and Lactobacteria.
There has also been found to be a link between intestinal permeability and inflammatory joint disease. That is, joint disease may be triggered through the gut.
Sophisticated stool studies may also check for evidence of inflammation and mucosal health. I routinely obtain these in my patients.
There are of course gene factors associated in autoimmune disorders. There has been an increased incidence of autoimmune diseases in families and increased incidence of autoantibody in the relatives of these patients as well as an increase incidence of diseases in monozygotic twins.
Gene factors in autoimmune disease have been located in chromosome 6 in the HLA regions.
Of note is that these autoantibodies occur before clinical onset of disease and are predictive of autoimmunity. Several nonrandomized small scale studies have suggested that autoimmune disease could be prevented if treated aggressively prior to the manifestations of symptoms. Individuals who are at high risk of developing autoimmune disease should be advised to refrain from activities and lifestyles which endanger their health and quality of life.
HORMONAL FACTORS OF AUTOIMMUNE DISORDER
Hormones, especially the female hormones of estrogen, have been implicated in autoimmune disorders. There have also been associated medications causing autoimmune disease.
DIET AND AUTOIMMUNE DISEASE
There is increasing evidence that the loss of intestinal barrier function typical of celiac disease and gluten sensitivity could be responsible for the onset of other autoimmune diseases.
The autoimmune response can be theoretically stopped and perhaps reversed if the interplay between autoimmune predisposing genes and triggers is prevented or eliminated by a prompt diagnosis and the treatment with a gluten-free diet.
This has been published in the Current Opinion Gastroenterology 2006 in November.
Other studies have shown that low concentration of arachidonic acid and high concentrations of the long chain N-3 fatty acids improve autoimmunity.
Vitamin D levels show an inverse relationship between multiple sclerosis, type 1 diabetes, rheumatoid arthritis, and inflammatory bowel disorder. Of interest to note, patients with autoimmune disease express genetic polymorphism of Vitamin D regulatory genes.
This would prompt all patients to check their vitamin D levels and vitamin D genes.
Physical and psychological stressors are also implicated in the development of autoimmune disorder. Approximately 86% of patients reported uncommon emotional stress before disease onset.
WHAT DO ALL THESE FACTORS HAVE IN COMMON?
They all contribute to “information” to modulate genetic expression of the immune system that can create cross-talk between self and nonself. The production of molecules through the exposure to chemicals, endogenous metabolites such as mercury, estrogens, etc., modify cellular composition and alteration of proteins, all contributing to the immune system to recognize the body as being foreign.
IMMUNE FACTORS IN AUTOIMMUNE DISORDERS
In autoimmune disease, there is modification of proteins with chemically altered DNA involving cross-linking, methylation, and oxidation.
These epigenetic modifications can be controlled by diet nutrients and intestinal flora, and they have been found to influence methylation acetylation related to the epigenetic process. These modifications of DNA have been demonstrated to have the potential to be passed on to the next generation, so we need to silence the abnormal immune system.
TESTING AND RECOMMENDATIONS
I perform an extensive history and physical and look at genes, toxins, infections and biochemical individuality.
Multiple antibodies are checked, and studies are obtained to rule out gluten sensitivity or celiac disease. Intestinal permeability tests, stool analysis, and complete nutritional status is obtained.
Heavy metal exposure is also evaluated using red blood cell minerals or heavy metal detoxification protocols.
Adrenal panels as well as vitamin D levels are also obtained. Inflammatory cytokine panel may also further evaluate the condition.
There is also evidence that certain estrogen metabolites alter the DNA to create a foreign DNA or antibody production.
These are also checked in my patients. Tests such as ANA, rheumatoid factor, CCP, TPO, TG, ASCA, ANCA, TTG, EMA, GAD, and many others including antimyelin antibodies are checked.
I feel that there is a dental connection with low grade dental infections such as in root canals and occult dental infections and also a amalgym (which contain mercury) filling connection.
The type of treatment is dependent upon the extent of pathologic changes or disease, whether there is a positive family history with no antibodies, antibodies present but no symptoms, and antibodies present with nonspecific symptoms. It is extremely important to note that the number of antibodies increases with pathologic changes.
I also evaluate infection and dysbiosis by evaluating bacterial overgrowth, yeast overgrowth, and parasites.
Evaluation for inflammation and food allergies is also obtained.
Depending on these studies, probiotics which stimulate anti-inflammatory cytokines and blocks NF-kappa B and stimulates IgA synthesis are given.
I ensure that all patients have adequate digestion as well as absorption along with vitamin D and hormones as indicated.
I believe that a diet that is good for the bowel health is important.
It is interesting to note that plant food saponins demonstrate increased gut permeability.
Dietary lectins have also been shown to enter peripheral circulation and cross the gut barrier. It is also thought that they increase gut permeability.
I counsel my patients to avoid vaccinations.
In humans, this may cause disease. Adjuvants have been added to these vaccines which elicit abnormal immunity responses. Autoimmune encephalitis, the animal equivalent of multiple sclerosis can be induced by injection vaccinations using Immunogen plus saponin.
There have been studies with multiple sclerosis and milk causing autoantibodies, and this should also be avoided.
The treatment of autoimmune disease is multifactorial.
It starts with a clean, healthy gastrointestinal tract.
I perform tests for gastrointestinal health and gastrointestinal permeability as well as inflammation.
Tests are performed to see if there is evidence of parasites, lyme, mycoplasma, fungus, or other bacterial infections present. Food allergies are tested for as well as vitamin D levels, hormones, and antibody panels. The dental connection is also evaluated.
Treatment consists of reducing intestinal permeability, decreasing inflammation, and lowering autoantibody levels.
Protein-rich polypeptides are also instituted along with colostrum, glutamine, probiotics, prebiotics, medium-chain triglycerides, and natural anti-inflammatories. If there is evidence of parasitic, fungal, or bacterial infection, they are treated appropriately.
I USE MANY IV THERAPIES WHICH REALLY HELP.
Autoimmune disease is on the rise.
If you suffer from one of the autoimmune disorders and wish to take a closer look at why you are suffering, please call my office for further information.
I use my therapies along with traditional immune-modifying drugs, but be aware that these drugs may have side effects, and I will work along with your rheumatologist or gastroenterologist to get the best possible result
DEAN R. SILVER, M.D.