Autoimmune disease like Crohns, Multiple Sclerosis, and Type 1 Diabetes, all present particularly daunting treatment challenges to medical and healthcare professionals. Even with our advanced knowledge of the human body and our tremendous advances in diagnostic and treatment options, it is difficult to bring autoimmune diseases into line.
Our understanding of many of the mechanics of autoimmune disease is considerable. It is our understanding of how these symptoms and causes connect within each patient that presents challenges. To better tell the tale of how this happens, let us begin describing a healthy immune system and how that looks in light of autoimmune disorders.
The Intact Immune System
Self-protection ranks up there as one of our body’s “must-do” actions if we ever expect to live long enough to reproduce. Starting with physical barriers like skin to protect the inner workings, our bodies build successive layers of physical and chemical barriers to keep the outside world outside.
The well-functioning immune system is part of our internal security system that provides a number of cellular responses to the occasional invading bacteria, virus or other bit of the outside world that manage to slip past some of the outer defenses. Breaks in the continuity of the skin allows foreign bodies (i.e. things that are not “self”) are threats that demand an immediate response. The same goes for parts of the body in an inappropriate place. E coli bacteria work wonders in our lower digestive tract but wreaks havoc if taken into our upper digestion in the form of contaminated food.
When these foreign invaders are discovered by the cells of our immune system, a challenge-and-response routine takes place. If a particle or microbes does not provide a recognized response, the immune cells respond to defend us from the invasion. Mobilizing a system wide response (like antibodies), the body does whatever it can to neutralize and eliminate the threat.
Memories
The impeccable design of our immune response also catalogs the known characteristics of the invaders for future reference. If the same bad actor shows up again someday in the future, our immune system is ready with the same specifically tailored responses it used the first time to defeat the invader.
Much of this should sound familiar as it is the basis of how vaccines work. In vaccines however, what is introduced into the body is just enough of the microbe for our body to recognize it again but not produce the full-blown disease. With any medical intervention, unintended consequences do sometimes occur. In the same way as the drug commercials we witness on television everyday list in frightening detail side-effects, pharmaceuticals have the ability to cause unintentional harm, as well as good. This information makes being an educated consumer of medical treatments even more essential.
The Bigger Picture
Getting back to immune function, like many systems of our physiology, organs and cells are specialized in their functions. They also function in one of two ways. Like a light switch, a cell is either “on” doing what it does or the cell is “off”. If not activated, cells wait until the need for their special talents returns. Cells generally are not multi-taskers doing something else while they wait for the next emergency.
In the immune response, antibodies are great examples of this on/off routine. Antibodies are keyed to specific cells. They attack only those types of cells. When there is no threat, antibodies hang out in circulation, on guard for the next incursion of “not-self” cells.
Absent a known threat, the inactive antibodies become recycled by the body. Not to worry though. Just because the antibodies are no longer present does not mean a loss of protection. There are still memory cells of the immune system that monitor our physiology continuously. If known bad cells happen to show up in the future, the memory cell gets the word out to build antibodies to deal with the problem.
Just as a footnote, this antibody presence or absence is why testing people for COVID-19 antibodies is a less than reliable way of trying to determine immunity status for the virus. Depending on how long ago a person fought the virus or received a vaccination, the number of circulating antibodies vary or are not evident at all. We unfortunately do not have a way to measure information stored in memory cells yet.
The Autoimmune Disease Response
Our immune system manages a big recognition challenge. It needs to be able to recognize all of the players in the game (cells, tissues, organs, bacteria, etc.) As I referenced before, e coli bacteria is beneficial in some parts of the body and a toxin when found in other parts of the body.
Autoimmune disease occurs when this highly sophisticated immune system glitches and determines that healthy body parts or cells are threats. The body attacks itself. These immune response miscues (the right response at the wrong time or place in the body) can be debilitating and are often deadly. The body attacking itself like this often appears to be a recognition problem. Somehow the ability to recognize “self” from “not self” has gone haywire.
Autoimmune Disease Connections
Causes of autoimmune responses are varied and often difficult to determine. No really knows for sure as it appears to result from a combination of factors.
A person’s genetics may make a person more susceptible to developing an autoimmune response. A person’s environment may also contribute to such a malfunction of the immune system. There are lots of theories and loads of contradictory evidence of causes.
Prior infections are often present before things breakdown. How that relates to system failure is still debated. As with the memory cells, we do not currently have the technology to measure what the immune system “knows’.
In the same way, lifestyle choices (as I may have mentioned a time or two) can affect the functioning of our bodies. A poor diet, sedentary lifestyle, tobacco, and alcohol may eventually weaken body systems to the point of malfunction. While nothing is proven to be a smoking gun, my knowledge of physiology and years of clinical observation, make this wearing down of the immune system one of my better theories as to the cause of a malfunction. As with any theory, I eagerly await the data that supports or refutes it.
Too Good of a Job
Even in dysfunction auto immune responses strongly mimic a normally functioning immune system. The response is strong and targets only particular cells/tissues. That is why such diseases can be so devastating. For a system that identifies and eliminates foreign invaders to the body, it is ruthlessly efficient. When aimed at the healthy body, the results can be tragic.
The all-or-nothing aspect of our immune response makes treatment all the more challenging. How do you turn down the part of the system that is going awry and not turn down the whole thing?
The answer is you can’t. Just listen to any drug commercial talking about biologics and note the list of known side effects. Common among many is an increased risk of infection. When you turn down the immune system to address an autoimmune response, you are also turning down the protection from outside sources of infection (viruses, bacteria, etc.)
Our Vital Link
Those of us from the holistic side of diagnosis and treatment like to think of solutions to the problems from the other side of autoimmune disease. Instead of further weakening a malfunctioning system, why not try to support and build back to a healthily function system?
As with so many aspects of this problem of autoimmune disease, treatments begin with identification. What lifestyle factors of the person could have been contributing to the problem?
- Has the person been living in the fast-food drive-thru too much?
- Are they living a traditional couch potato lifestyle?
- What is their intake of substances with known toxic side-effects (alcohol, tobacco, pharmaceuticals)?
- What is their intake of fluids (even water!)?
- Are there other allergies?
The search will go into all corners of a person’s life in search of things that can be changed to support a healthier functioning of their immune system. The idea is to take all the accumulated information and make positive changes. Replace the poor health outcome choices with better ones.
Once possibilities are identified, changes will be made that support a healthier system. The downside is that the best outcomes to be expected still appear to be treating the symptoms of autoimmune disease. Disease management is our best hope until causation and treatments are found.
As with many life-altering events, an autoimmune illness is almost guaranteed to cause you to re-evaluate your priorities.
― Joan Friedlander
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