Autoimmune disease prevalence has been on a continuous rise, and is estimated to continue to increase at a rate of 19% per year. That number is outrageous and quite frankly scary! To understand why this rate continues to rise and to combat it, means we need to pinpoint what is autoimmune?
Approximately 1 out of 9 women have an autoimmune disease and 1 out of 12 adults. There are about 50 million Americans suffering from 80-100 different autoimmune diseases. The scary thing is, only about 24 autoimmune diseases have actual known mechanisms. I can’t tell you how many people I know, that have come to me, since I started my blog, and told me they have an autoimmune disease. I see this surge to be an epidemic in the medical community and we truly need to understand the how and the why behind it. Let’s dig deeper as to why there is a rise in autoimmune- and how we can attempt to minimize it.
What is autoimmune?
How about a simple formula?
Genetic predisposition + environmental trigger + intestinal permeability = autoimmunity
With this formula we can control 2 out 3 of these, thus preventing autoimmunity and the development of autoimmune disease. When we put all three factors together we obviously get autoimmunity. Autoimmunity is when the immune system is directed at a self-antigen or self -tissue.
Remember, autoimmunity is the mechanism, but autoimmune disease is the disease that results from the mechanism when a tissue or organ is being destroyed.
So, I want to start by defining a few key players in the immune system:
- Antibodies: proteins that are made by the immune system that bind to foreign material and fight them
- B-cells: are responsible for making antibodies
- T-cells – have 2 subtypes, CD4 (helper cells) and CD8 (killer cells). CD4 helpers are telling all the other cells what to do.
- Antigen- a toxin or other foreign substance which induces an immune response in the body
- Macrophage – Macro means big and PHAGE means eater, so we have our big eater cells- and they pretty much each anything.
- Cytokines – large groups of proteins and peptides that are secreted by cells in the immune system and work as messengers to regulate immunity and inflammation
Let’s start at the root of how we develop immune cells within the body. Usually when B and T cells are made in the bone marrow they go through a testing process while they are STILL in the bone marrow. If they are specific for self, they kill themselves- this is autoreactive, and obviously meant to protect us from developing an autoimmune disease. This process is called CENTRAL TOLERANCE. Clearly our fascinating human body has a mechanism to control for autoimmunity, so what’s the problem… why do we see a continuous rise? Well, let’s start with focusing on the complexities of the body and how things can go wrong.
While our body has a mechanism to automatically kill immune cells that are specific to self tissue, some of the cells escape tolerance before dying off!!!
Because this happens we need a SECOND mechanism for tolerance. What this means is we basically need TWO signals to activate a T-cell.
The first signal is when a macrophage presents an autoimmune antigen to a T-cell.
The second signal is when CD 86 on the macrophage binds to CD 28 on the T-cell.
Let’s talk about how we get CD-86…. If a pathogen or virus enters the blood stream, that signals danger to our macrophage and so it sends out the troops (CD-86) and puts CD-86 on it’s surface. Basically, it’s like its waving the white flag to our T-cell, and so it activates the T-cell to attack. If we don’t have CD86 the T-cell will just die off
So what’s the difference between autoimmunity and inflammation… Let’s break that down:
|Non-specific innate immune system involved||Specific immune system involved|
|Macrophages, neutrophils and mast cells – produce pro-inflammatory cytokines IL1, IL6 and TNF-alpha||Activates B cells and T cells – produce IL17 and TH1 and IFN gamma autoantibodies produced to specific antigens|
|We get tissue damage as a result of chronic inflammation||We develop autoimmunity as a result|
Again…. Not only do we want to know What is autoimmune…. but how do we get autoimmune disease?
Let’s dig in and summarize three mechanisms:
- Preferential tolerance: preventable
- Bystander effect: nothing you can do to prevent this
- Molecular mimicry: nothing you can do to prevent this
Let’s start with the complex mechanisms that explain…. what is autoimmune?
Bystander effect, what does that actually mean? Well, really it is what it sounds like. In this case we get extra CD-86 which keeps the T-cells turned on. Your body is fighting something foreign and your SELF gets in the way and your body fights BOTH as a bystander. This is the most common mechanism of how we get autoimmune disease.
This happens when your body simultaneously responds to a foreign antigen-VIRUS and self antigen… YOU!
As a response to a virus our body signals danger to our macrophages who are like little monsters that are released to eat up the bad guys. Macrophages are always eating things, but when it eats a SELF antigen you have a problem. The macrophage can then present this self-antigen to our immune system, and if your immune system is already turned on due to an infection – it may see that antigen with a danger signal and respond. As a result, the body is attacking itself as well as the virus. This is why we call this a BYSTANDER effect.
The second mechanism that helps us get to the root of answering, what is autoimmune is….
Molecular mimicry: this is when a foreign antigen (virus) imitates a self-antigen causing the immune system to think its attacking something foreign when really, it’s attacking itself.
Lastly, stressors and mental emotional problems can trigger autoimmune disease. Let’s talk about how anxiety can trigger autoimmunity. High levels of anxiety increase IL-6 levels resulting in an increase in TNF-alpha. There are pro-inflammatory cytokines that result due to inflammation. Now in a normal situation, your T-cells that are self-specific SHOULD be producing TGF-Beta, but in the presence of IL-6 and TNF-alpha- instead of producing TGF-beta which is protective, the T-cells actually produce TH-17 which is pathogenic or BAD!
An additional contributor to development of autoimmune disease has to do with the hormone cortisol. In normal conditions, our cortisol levels peak when we wake up and slowly drop throughout the day until it’s time for bed and that’s how we go to sleep. In some individuals, who lead highly stressful lifestyles, have a flat lined cortisol level, and they never get that peak. That is a BIG problem! That peak is essential to regulating our immune system, because this is another mechanism by which autoreactive cells die. When we get that peak first thing in the morning, our body kills off those autoreactive cells that escape the bone marrow. Without that peak because of imbalanced hormonal function, those autoreactive t-cells can get into the periphery and cause autoimmune disease.
So now that we have answered WHAT IS AUTOIMMUNE – the question is why are we seeing such a rise and increase in incidence of autoimmune?
A main reason is because of how closely the gut effects the immune system, this is hypothesized as the primary reason for the growing epidemic in developing autoimmune disease. Our gut microbiome is responsible for producing TGF-beta (Remember that is protective and balances our immune system). We know that TGF-Beta is the primary cytokine that keeps autoimmune disease under control. If we have leaky gut, or an altered gut function we reduce TGF-Beta and thus alter that mechanism that controls autoimmunity.
So, lets focus on 5 preventable and modifiable risk factors that can lead to autoimmune development:
- Dietary habits: For people who are eating a standard American diet – the prevalence of autoimmune disease is elevated. This diet is high in processed foods, additives, high in sugar and trans fats, and promotes inflammation.
- Environmental surrounding: We have changed our lifestyle and spend majority of our time indoors leading to very low vitamin D levels- we will talk more about this in future posts on vitamin D and its relation to immunity.
- Too clean – we are so scared of dirt! We don’t garden anymore so we have no exposure to soil bacteria. Everyone is so worried about “getting sick” that vwe are getting even more sick! Our infectious habits have changed.
- Pollution – more chemical exposure in our atmosphere, in our food supply, diesel exhaust, personal care products, makeup.
- Excessive stress: This will continue to impact autoimmunity through various mechanisms. Our lives have become so fast paced and high stress.
It’s important to understand the underlying mechanisms of the immune system and how autoimmune develops.
How can we manage our disease if we don’t understand what is autoimmune?
All in all, we talked about the mechanisms by which autoimmune disease develops. While we can’t alter our genetic predisposition to autoimmune disease, we can certainly change its expression. We have the ability to control and prevent or delay the onset. When you think about the question we are answering, WHAT IS AUTOIMMUNE, I want you to remember the simple formula we talked about early on:
Genetic predisposition + environmental trigger + intestinal permeability = autoimmunity
Keep in mind the environmental triggers we discussed and exposure to various toxins that can alter our immune health. But just as important, gut health is key! Majority of our immune system begins in the gut, so what we expose to our intestinal environment impacts overall health prevention and disease development. When you hear the phrase, you are what you eat, it’s true! Eat healthy, vegetables that are lively and full of nutritious benefits- then you will be the same, Lively and nutritious! Eat processed foods full of chemicals and garbage, your body will feel like garbage, be sluggish and be more prone to developing disease.
Autoimmune disease is on the rise and unfortunately will continue to rise because of our ever changing and convenient lifestyle we have created as human beings. Keep educating yourself and implementing what you learn. I am an avid believer that even the slightest change will make a difference. We can only control what we can control- so take your health into your own hands and make a change. Stop your disease before it stops you, and if you have already developed it and understand how it came to be- take control and delay progression. Balance your overall health with nutrition and medicine and live your best life!
Subscribe below to get my summary of the top infections that have been correlated to autoimmune disease. Be aware of what these infections are and balance your immune system. Remember how autoimmunity develops and how it impacts our immune system. Stay tuned for a summary on how to boost our immune system and prevent the development of autoimmune disease!