Autoimmune disease affects an estimated 23.5 to 50 million people in the US and is one of the top ten leading causes of death in females in all age groups up to 64 years of age. (1)
Autoimmune diseases include Hashimoto’s thyroiditis, systemic lupus erythematosus, Sjogren’s syndrome, multiple sclerosis, rheumatoid arthritis, Grave’s disease, scleroderma, among many others. Current mainstream treatment generally consists of controlling symptoms and slowing the progression of disease with medications that often have negative side effects. (2) However, there are other alternatives to conventional medicine that may yield positive results when used with or without mainstream treatment.
Functional medicine is an approach that allows a healthcare practitioner to evaluate an individual as a whole, rather than a set of symptoms. When a practitioner is able to look at the whole of an individual, they are more aware of strengths and weaknesses of each body system, how they work together, and how they affect each other. (3)
A functional medicine approach to medicine is guided by six core principles:
- An understanding of biochemical individuality based on genetic and environmental uniqueness
- Awareness of evidence that supports a patient-centered approach rather than a diseasecentered approach to treatment
- Balance among the internal and external factors in a patient’s body, mind, and spirit
- Familiarity with the web-like interconnections of internal physiological factors
- Identification of health as a positive vitality-not merely the absence of disease
- Promotion of organ reserve as the means to enhance the health span, not just the life span of each patient (4)
Functional medicine’s whole system approach includes preventative interventions utilizing interventions such as: drugs, botanical medicines, supplements, therapeutic diets, detoxification programs, physical activity, and stress management techniques.
The functional medicine approach to autoimmune disease works to create balance and thus decrease symptoms and improve outcomes. Autoimmune disease is thought to develop as a result of genetic, environmental, and lifestyle factors. (5)
In functional medicine, leaky gut syndrome is thought to play a significant role in the development of autoimmune disease. Leaky gut can occur as a result of inflammation that compromises the intestinal lining.
Normally only about 2% of food proteins (that the immune system can recognize as a threat) get through the intestinal barrier. In leaky gut, tight junctions (which selectively allow intestinal contents through to the blood) are compromised, and much more than 2% is able to get past- including bacterial toxins. This can activate the immune system’s inflammatory pathways and lead to chronic inflammation which can develop into autoimmune disease. (6)
Some research shows that estrogen replacement therapy or use of oral contraceptives increases the risk of developing some autoimmune disease. Also, because autoimmune diseases affect significantly more women than men, estrogen dominance is suspected on being a factor in the development of autoimmune disease.
Estrogen dominance may be related to high intakes of meat, poultry and dairy products treated with hormones as well as xenoestrogens from pesticides and environmental toxins. Low fruit and vegetable intake may also contribute to estrogen 4 dominance. Fruits and vegetables contain phytohormones which can mediate estrogen levels. However, only about 32% of women eat at least 5 servings of fruits and vegetables a day. Choosing hormone-free meat, poultry and dairy foods along with increasing organic fruit and vegetable intake may help improve estrogen balance.
Other dietary changes that might benefit those with autoimmune disease are very low fat, vegan and gluten-free diets. Very low fat diets have shown improvement in mortality rates as well as slower deterioration. This may be due to decreased oxidative stress.
In addition to dietary changes, replenishing antioxidants may also be beneficial. Those with autoimmune disease have higher levels of oxidative stress and inflammation.
Many studies have mixed results, but perhaps this is because most studies only evaluate the effectiveness of single antioxidants. Antioxidants work synergistically to reduce oxidative stress as well as regenerate each other. When single antioxidants are supplemented, other antioxidants are not present to regenerate- which increases oxidative stress. Supplementing multiple antioxidants is likely to provide a more oxidative protective effect.
Omega 3 supplementation has shown significant promise with autoimmune disease. Some clinical studies have shown omega 3 supplementation to bring about clinical remission of lupus without negative side effects. Generally, supplementation of 3.6 grams of omega 3 daily has provided positive results in reducing inflammation. However, low fat diets may decrease the amount of fish oil needed.
Another area of therapeutic interest is the role of the gut in autoimmunity. Oner Ozdemir explored the current research in the treatment and prevention of autoimmune disease because of the widely accepted role of gut bacteria in immunity. In reviewing more than 50 experimental (animal) and clinical (human) studies, several positive benefits were found by supplementing various probiotic strains. Among the benefits for autoimmune disorders were decreased antiinflammatory effect, decreased gut permeability, improved immunoregulation, decreased T-cell response, and decreased cytokines. All of which can benefit those with autoimmune disease.
Probiotics in clinical practice:
While Ozdemir’s review didn’t provide definitive evidence for using probiotics in autoimmune disease, probiotics may be helpful in patients with autoimmune disease who are also experiencing gastrointestinal (GI) issues. There is significant evidence for using probiotics in a variety of GI issues. (7,8,9)
The anti-inflammatory effect can be a potential added bonus until further research provides more clarity and understanding for best practice in using probiotics as treatment for autoimmune disease. A patient’s GI health and possible dysbiosis should be assessed and treated appropriately. It has been suggested that multiple strains of bacteria be used in the amount of 3-30 billion live cultures daily to prevent or address health issues.
This is the future. A functional medicine approach to autoimmune disease can include: correcting hormone imbalance, dietary changes, correcting nutrient deficiencies, providing adequate antioxidants, increasing omega 3 intake, and correcting gut bacteria balance. These interventions can be used in conjunction with traditional therapies as is appropriate to improve patient outcomes.
1. American Autoimmune Related Diseases Association. Autoimmune statistics. Accessed 2/17/15. http://www.aarda.org/autoimmune-information/autoimmune-statistics/
2. Lieberman S. Natural interventions for treating autoimmune diseases. Alternative & Complementary Therapies.2001;7(6)341-6349
3. The Institute for Functional Medicine. What is functional medicine? Accessed 1/28/15. https://www.functionalmedicine.org/about/whatisfm/
4. Institute for Functional Medicine. Core Principles of Functional Medicine. Accessed 1/28/15. https://www.functionalmedicine.org/files/library/six-core-principles.pdf
5. Ozdemir O. Mechanisms of preventative and therapeutic roll of probiotics in different allergic and autoimmune disorders. Open Journal of Immunology. 2013;3(3):103-118.
6. Lord R, Bralley A. Laboratory Evaluations for Integrative and Functional Medicine. 2 nd ed. Duluth, GA: Metamatrix Institute; 2012.
7. Huffnagle G, Wernick S. The Probiotics Revolution. New York: Bantam Books; 2007.
8. Kopp-Hoolihan L. Prophylactic and therapeutic uses of probiotics: A review. JADA. 2001;101(2): 229-241. doi: 10.1016/S0002-8223(01)00060- Accessed 2/17/15.
9. Douglas, L. C., & Sanders, M. E. Probiotics and prebiotics in dietetics practice. JADA.2008;108(3): 510-521. doi: 10.1016/j.jada.2007.12.009. Accessed 2/17/15.