Controversies and strategies in autoimmune disease epidemic

There’s no doubt that autoimmune disease is on the rise in epidemic proportions, said David Brady, ND, DC, CCN, DACBN, IFMCP, director of the Nutrition Institute and associate professor of clinical sciences at the University of Bridgeport in Connecticut, at the at the 2019 Integrative Healthcare Symposium.

We are in the age of genes and SNPs, said Brady, but this it not a genetically-driven phenomenon.

“Genes don’t change that quickly,” Brady said. “This is about the way our modern environment is dancing with our genes and how it effects our gene expression.”

Brady led a panel of autoimmune disease experts, which included Nancy O’Hara, MD, MPH, FAAP, pediatrician at Nancy O’Hara & Associates, David Perlmutter, MD, FACN, ABIHM, neurologist, author, and lecturer at Empowering Neurologist, Yehuda Shoenfeld, MD, FRCP, MACR, chair for research of autoimmune diseases and head of The Mosaic of Autoimmunity Project at Tel Aviv University in Israel and Saint Petersburg University in Russia, and Aristo Vojdani, PhD, MSc, CLS, CEO and technical director of Immunosciences Lab.

The experts agree the microbiome, leaky gut, and leaky blood-brain barriers should be top-of-mind when discussing autoimmune disease.

Studies show that 70 percent of autoimmune disease risk is associated with the person’s environment, whereas 30 percent is associated with their genetics, according to Vojdani.

“Pay attention to the environment because we cannot change our genetic makeup,” he said. “But we can change our environment.”

This environment includes not only where the person physically resides, but also the food they eat and the toxins they are exposed to, which may include cosmetics or other products used on a daily basis. Vojdani says a predictive autoantibody test would help patients measure their risk for autoimmune disease.

However, Perlmutter says that’s a couple of steps down the line. If someone has elevated antibodies, he said, the likely have a leaky gut.

“Rather than measuring it and being retrospective, why don’t we emphasize measuring markers of gut permeability or institute measures to promote gut integrity long before we have these predictive autoantibodies,” he said.

Prediction is nice, said Shoenfeld, but autoimmune disease can be prevented with a number of measures, including: 

• Vitamin D supplementation
• Avoiding exposure to sun
• Proper diet
• Physical activity

“There are measures we can recommend to patients that may slow down or lead to prevention of autoimmune disease,” said Shoenfeld.

Perlmutter expanded on Shoenfeld vitamin D suggestion, adding autoimmune disease have a latitudinal gradient and the relationship to vitamin D and autoimmune diseases is powerful, especially in regards to the brain, he said.

“This is a simple modifiable lifestyle factor that has a huge role to play in regulating the immune system,” said Perlmutter.

When you talk about prediction and prevention for disease, you have to give life, Shoenfeld said. This means no or minimal side effects and no contraindications, and vitamin D meets these criteria. While there is no strong evidence that it can prevent autoimmune disease, it can ameliorate or postpone, he said.

The gut-brain connection also plays a role in the autoimmune discussion. Our risk for autoimmune disease is influenced by our lifestyle choices, said Perlmutter.

“The host is the underrated player here,” said Perlmitter. “Yes, we have bacteria and viruses in the brain, but we have to look at the host in terms of his or her tolerance and ability to respond appropriately.”

The key to autoimmune disease is preventative medicine:

• Predictive testing
• Genomics
• Microbiomics
• Family history

“You can truly know who will likely develop an autoimmune disorder unless they change their environment,” said Shoenfeld. “This can alter the paradigm in how autoimmune disease is managed clinically and prevented.