The nascent field of immunity was just in its infancy, limited to microscopes and mouse experiments, and lacking the advantages of advanced genetic and molecular testing available in today’s labs. While several cell types had been known to be associated with an immune reaction, identified through techniques of cell staining known as Gram’s staining (still widely in use across the country today), concepts of molecules such as an antibody were still just theories, borne from careful observation and animal serum experimentation.
To an individual today struggling with an autoimmune disorder, the descriptive concept of an self-directed horror likely rings true. Autoimmunity, the phenomenon in which the human immune system incorrectly recognizes and attacks one’s own tissues, is hardly a rarity in today’s society. It is assumed that the incidence of an autoimmune condition, now generally thought to include some 70-80 different diseases or conditions, in known to be present in 1 in 12 Americans. This means that more than eight percent of our population is experiencing decreased health due to an ongoing, self-directed inflammatory response. On a daily basis, more than eight percent of the population is continually struggling with the four clinical signposts of an inflammatory condition: calor (heat), rubor (redness), dolor (pain) and tumor (swelling or growth).
But this may be the proverbial tip of the iceberg. Eight percent of the population is known to be afflicted. As autoimmune disorders are not necessarily reported to a central agency such as the Department of Health, the incidence of disease in our population may be much higher. And there is good data to support this. To begin with, autoimmune diseases are on the rise across America and the World.
Between 2001 and 2009 the rate of Type 1 diabetes, long known to have an autoimmune connection (without clear knowledge of the exact triggers or mechanisms), increased by 23% according to he American Diabetes Association. Celiac disease, the only AD that has allowed its mechanism to be fully elucidated in terms of the genetic, cellular and environmental factors, has become 4 times more prevalent in the last 60 years. Celiac Disease now affects approximately 1% of the American population. Rheumatoid Arthritis is similarly on the rise in women, increasing 2.5% each year with a lifetime risk of around 4% in women, and 3% in men.
Many studies, looking at banked blood, have shown that the autoimmune process, diagnosed by the presence of certain antibodies in the blood, may precede the clinical manifestations of a person’s disease by 5-10 years. How many people are secretly harboring antibodies, to develop (or not) an illness in the future? Only time, or increased testing, will tell.
So why is our body seemingly finding a need to mount an inflammatory response more and more frequently against our own tissues?
The answer to this question is best approached by asking another question. This is “what is the job of the immune system as a whole?” While a full understanding of this question may be still unanswered after a several-year course of graduate study in immunology, there are several things known today to help bring this to light.
When I was in medical school over twenty years ago, the commonly held explanation of the immune system was only in regard to the recognition of “self” versus “non-self”. The immune system, through certain groups of immune cells, was poised to survey the body for molecules that were not “self”. When a “non-self” molecule was identified, the four horsemen of inflammation (calor, rubor, tumor, dolor) were sent into motion and the invading organism was brought to its proverbial knees, killed by the onslaught of toxic chemical released by the immune cells.
These toxic chemicals, hydrogen peroxide (H2O2), bleach (HOCl), and activated oxygen molecules, destroy the invading organism, but in doing so leave behind a swath of destruction that involves our healthy tissues as well. This molecular “friendly fire” is an accepted trade-off , damaging some normal “self “ tissue with the removal of the “non-self” organism. Over time the native tissues would heal, and in theory the animal would return to a non-infected, fully whole organism through cellular replication and modeling.
A more contemporary understanding of the immune system now shows that the immune system’s interface with our environment is far more complex than simply determining whether a molecule is part of our own body or not. The task at hand is more the recognition of “dangerous strangers”. Ironically many of these strangers, to include many bacteria, yeast species and helminthes (worms), are not seen by the immune system as “dangerous”, but as microbiological inhabitants that can modulate and improve our immune function. Several studies has shown that certain probiotic bacteria actually promote decreased immune activation and inflammation. Conversely an infection with a food borne bacteria, like the Escherichia Coli picked up at the local Jack in the Box, provides a quite different stimulus to the immune system, which rapidly responds with inflammation: fever (calor), distension (tumor), and cramping belly pain (dolor).
So we now know that one of the important functions of our immune system is to recognize molecular signals in the environment. These molecular signals can come from external to our body in the form of toxins, bacteria or helminthes, or they may come from within our bodies in the forms of oxidized fats, cellular debris, poorly digested foods or other inflammatory signals. Our immune cells then direct the rest of the system to respond with either an exaggerated, uncontrolled inflammatory response- as would be seen in an autoimmune disorder- or with one that is balanced. Ideally the system is in balance, with an ability to mount an appropriate response to a danger signal, while maintaining the ability to turn off the response off once the threat has been removed.
The primary job of an immune system is to guard barriers. It is through these barriers that the outside world gains access to our fortress, our body. We have all watched the healing process when we heal a cut on our hand or knee. This is the immune response on our largest organ, the skin. The allergic reaction to a dust particle, bit of cat fur, or seasonal pollens shows the immune system’s response to a “dangerous stranger” in our sinuses.
The final frontier for immunity is the gut, a massive organ which if fully unfurled and laid flat would cover the area of a doubles tennis court. A typical virus measures approximately one billionth of a meter in diameter. Now imagine the immune system’s job of having to survey the entire gut for dangerous strangers. It is truly Herculean. It is no wonder that a full 75% of all of the immune cells in the body are found within one centimeter of the lining of the gut.
So where did your autoimmune condition come from? Unless you are a celiac, with known triggers (gluten) and genetic predispositions (HLA DQ-2 and DQ-8) much of what we understand about specific diseases carries a bit of speculation. But in having a good idea of what an immune system is surveying for, and the barriers it is trying to protect, many avenues open to modify the environment to allow the immune system to find a state of balance. With functional medicine, we will look to improve the barriers in the gut and the skin. We can use foods and probiotics to repopulate the gut with bacteria known to whisper calming, reassuring messages to the immune cells; we can use safe, herbal and nutritional therapies to suppress the inflammatory pathways. We can ensure that no inflammatory foods are contributing to the immune response, much in the way that the elimination of gluten fully cures celiac disease.
We cannot change a person’s genetics. At least not today. But with a coordinated approach based in current gastrointestinal, cellular and immunological science, we may be able to stem the immunological (rip)tide, and return one’s immune system to a state of optimal function, and the body to a state of symptom-free health.
Dr. Scott Resnick