Naturopathic Approach to Autoimmune Conditions
By Keith Wilkinson, NMD.
From a naturopathic perspective, the body functions as a logical organism that responds in a direct cause and effect relationship to its environment. In the case of auto-immunity and its symptoms, the immune system (the effect) is responding to something that appears to be "foreign" (the cause) in the body. Unfortunately, in the process of trying to remove the foreign substance, the body destroys its own tissue and auto-immunity develops.
From a conventional medicine perspective, much of the treatment focuses on minimizing the symptoms of pain and inflammation using non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen and aspirin, steroidal anti-inflammatories such as prednisone, and in more severe cases disease modifying anti-rheumatic drugs (DMARDs) that inhibit immune function such as methotrexate and plaquenil. Because these drugs can provide quick pain relief and slow disease progression, they are a necessary tool in the treatment of auto-immunity. However, in order to understand the cause and effect relationship in the genesis of auto-immune conditions, naturopathic medicine is also a necessary tool. Because of its broad focus on diet, lifestyle, environmental exposure, physical and emotional stress, etc., naturopathic medicine can take a more "upstream" approach to try to understand what may be triggering the body’s auto-immune reaction and the necessary steps to restore health.
Women Hit Hardest by Auto-Immune Diseases
An important unifying theme in autoimmune diseases is a high prevalence in women(3,4). Conservative estimates indicate that 6.7 million or 78.8% of the persons with autoimmune diseases are women (3).
Autoimmune diseases were first recognized more than a century ago researchers began to associate them with viral and bacterial infections. Autoimmune diseases tend to cluster in families and in individuals (a person with one autoimmune disease is more likely to get another), which indicates that common mechanisms are involved in disease susceptibility. Studies of the prevalence of autoimmune disease in monozygotic twins show that genetic as well as environmental factors (such as infection) are necessary for the disease to develop (5).
The following are some general naturopathic approaches to working with auto-immunity.
As a foundation for health, a naturopathic doctor will nearly always begin treatment by understanding the patient’s diet. To a naturopath, food not only provides fuel for the body, but is a powerful "medicine" that can be used to restore and maintain health. By maximizing foods that inhibit inflammation and consuming a whole-foods plant based diet, the patient can see the tremendous impact basic nutrition has on health. From here the real investigative work to find the root causes of the auto-immunity begins.
One area to start is by looking at food allergies. To many people, food allergy means the anaphylactic immediate reactions seen with foods such as peanuts or shellfish. However, in the case of auto-immunity, patients could be having food reactions that are insidious and delayed by several days. The "gold-standard" for assessing food allergy is through a food elimination and re-challenge diet. By eliminating foods that are common allergens (milk, eggs, grains, peanuts, gluten, food additives, preservatives, etc.) and eating a diet of simple foods, inflammatory reactions caused by the allergenic foods are allowed to subside. Once the patient is on a simplified diet for severaldays/week, foods can be slowly reintroduced. Noting improvement of symptoms during the elimination phase or worsening of symptoms during the re-introduction phase provides valuable information about the role foods may be playing in the auto-immune process.
In addition to the food elimination diet, food allergies can also be assessed through blood analysis. If the body is having a delayed/chronic reaction to certain foods, the immune system will make immunoglobulin G (IgG) class antibodies against the food. By testing blood against 90+ different food types, IgG Food Allergy panel testing can also provide a quick assessment of the possible role of food allergies in the auto-immune condition.
It may not seem obvious, but the gut is actually a tube going through the body that is open to the outside environment via the mouth. Because of this, over 60% of the body’s immune system (lympathic tissues/nodes, immune cells, etc.) resides in the gut. A healthy GI provides "surveillance" against pathogens and functions as a barrier to prevent passage of foreign particles into the body interior. However, in the case of auto-immunity, there is often intestinal inflammation that challenges the surveillance and then compromises the barrier function due to improper cell to cell junctions lining the gut wall. These improper cell junctions lead to a condition called "leaky gut" where undigested and potentially antigenic food particles and/or foreign pathogens can be released into the blood stream leading to auto-immune reactions. Additionally, the gut flora which is vital for GI health is often out of balance or dysbiotic creating further challenges for the immune system.
To assess GI function, stool analysis can be performed which assesses the presence of beneficial bacteria, pathogens, GI inflammation, digestion function, leaky gut, etc. To restore gut function, various treatments are available including amino acids and proper fats to restore gut tissue, probiotics to restore proper flora, botanical and supplements for a variety of mechanisms.
The naturopathic approach to environmental medicine recognizes that everyone is exposed to chronic low dose pollutants in the air, water, and food. These pollutants pose a toxic load that the body must regularly rid itself of through the pathways of elimination (i.e., feces, urine, perspiration, and respiration.) Unfortunately, if the body’s excretory functions are inhibited or if one is exposed to levels that overwhelm normal elimination, it poses a burden on the body that can often show up as auto-immunity.
In working with an environmentally sensitive patient the first task is to reduce ongoing exposure to pollutants. This is accomplished through taking a detailed patient history and then working with the patient to establish avoidance plans. Next, the current toxic load on the body can be assessed through heavy metal challenge testing, oxidative stress makers, metabolic testing, etc. Since the liver is the major organ used for the biotransformation of toxins, testing can also be done to assess adequate liver function.
After baseline testing is completed, environmental treatment can be as simple as improving bowel function through dietary modification and additional fiber or more comprehensive through treatments such as heavy metal chelation, improving liver function with supplementation and botanical medicine, improving nutrient status through supplementation and IVs, etc.
In addition to the physical contributors to environmental toxicity, the psycho/social aspects of daily living also pose a "toxic" load that must be processed by the body. By recognizing the effects of stress on the body and creating mechanisms for dealing with stress, the total body burden from all environmental stressors can be reduced.
Arthritis Health Provides Comprehensive Care
Auto-immune disease is a complex process that poses a challenge for any physician. By addressing immediate needs through conventional medicine and using naturopathic medicine to uncover causes for the disease process, a truly comprehensive care option is provided for the patient. At Arthritis Health, we provide the focus of rheumatology and the breadth of naturopathic medicine to offer such care. Dr. Keith Wilkinson is the naturopathic physician on staff at Arthritis Health. To learn how he would work with you, please give him a call.
- Kitts D. Bioactive substances in food: identification and potential uses. Canadian Journal of Physiology and Pharmacology. 1994; 72:423-434.
- Guengerich F. Influence of nutrients and other dietary materials on cytochrome P450 enzymes. American Journal of Clinical Nutrition. 1995;61:651S-658S.
- Nho CW, Jeffery E. The synergistic upregulation of phase II detoxification enzymes by glucosinolate breakdown products in cruciferous vegetables. Toxicol Applied Pharmacology. 2001;174:146-52.
- Goyer R. Nutrition and metal toxicity. American Journal of Clinical Nutrition 1995;61:646S-650S.
- Bland J, Barrager E, Reedy R, Bland K. A medical food-supplemented detoxification program in the management of chronic health problems. Alternative Therapy Health Medicine. 1995;1:67-71.
- Rea WJ, Pan Y, Johnson AR, et al. Reduction of chemical sensitivity by means of heat depuration, physical therapy, and nutritional supplementation in a controlled environment. Journal of Nutrition Environmental Medicine. 1996;6:141-148.
- Adam O. Anti-inflammatory diet and rheumatic disease. European Journal of Clinical Nutrition. 1995;49:703-17.
- Kjeldsen-Kragh J. Rheumatoid arthritis treated with vegetarian diets. American Journal of Clinical Nutrition. 1999;70 (suppl.):594S-600S.
- Gamlin L, Brostoff J. Food sensitivity and rheumatoid arthritis. EnviorTox Pharm. 1997;4:43-49.
- Benno P, Alam M, Henriksson K, et al. Abnormal colonic microbial function in patients with rheumatoid arthritis. Scandinavian Journal of Rheumatology. 1994;23(6):311-15.
- Smith MD, Gibson RA, Brooks PM. Abormal bowel permeability in ankylosing spondylitis and rheumatoid arthritis. Journal of Rheumatology. 1985;12(2):299-305.
- Lizko NN. Stress and intestinal microflora. Nahrung. 1987;31(5-6):443-47.
- Roland N. Nugon-BaudonL, Rabot S. Interactions between the intestinal flora and xenobiotic metabolizing enzymes and their health consequences. World Review Nutrition Diet. 1993;74:123-48.
Author Keith Wilkerson is a naturopathic medical doctor living and working with patients in Arizona, specializing in Rheumatology, Acupuncture, and Yoga Therapy.
More about Dr. Wilkerson at Integral Naturopathic Medicine
Going Against the Grain Dr. Peter Glidden explains how wheat gluten affects essential nutrient absorption.