Lifestyle and Environmental Factors may be Causing Increase in Autoimmune Disease

Dr. Tereza Hubkova, MD, ABIM, ABIHM, IFM, discusses autoimmune diseases in this issue of Health Hunters. She is a strategic partner of the Riordan Clinic. 

By Dr. Tereza Hubkova

The last few decades have brought a steep rise in autoimmune diseases. Autoimmune diseases occur when our immune system attacks parts of our own bodies. When diseases start occurring at epidemic rates, it suggests that environmental and/or lifestyle triggers are contributing factors. Genetic predisposition to autoimmunity contributes about 30 percent of the risk.¹ More than 100 autoimmune diseases exist.² Common autoimmune diseases include Hashimoto’s thyroiditis, Grave’s disease, rheumatoid arthritis, lupus, type 1 diabetes, psoriasis, multiple sclerosis, inflammatory bowel diseases, and, increasingly, celiac disease. They affect more women than men and are among the top ten causes of death in women under 65 years of age.³

We need to do a better job getting to the root causes of autoimmune diseases, educating people about ways they can lower their risk, and addressing the environmental and societal factors that fuel the epidemic. Functional medicine practitioners believe lifestyle choices and environmental factors could play roles in autoimmune diseases, and research increasingly confirms that. 

The Western diet seems to be a major trigger of autoimmunity and inflammation, especially due to the lack of dietary fiber and nutrients that are needed to support a healthy gut microbiome. Individuals often eat too many processed, artificial, and inflammatory foods and too much of the wrong fat, salt, and sugar. Disruption of the gut microbiome by the “Standard American Diet” (quite appropriately abbreviated as SAD) and “leaky gut” leads to the introduction of food antigens and microbial components into our body, causing chronic inflammation and contributing to autoimmunity. ⁴

Gluten is a particular problem for many people. Celiac disease, a hypersensitivity to gluten that leads to difficulty digesting food, was once considered rare. It is now estimated to affect 1 in 100 people.⁵ In celiac disease, autoimmunity affects almost any organ from the pancreas to the brain. Most people with celiac don’t know they have it, and the diagnosis can be delayed by as many as ten years. The Celiac Disease Foundation reports that only about 30 percent of people who have celiac disease worldwide are properly diagnosed.⁵ If we do not test our patients with autoimmune thyroid disease for celiac and get them on a gluten-free diet, we are missing an opportunity to prevent or delay another autoimmune disease they might otherwise develop later. 

Inflammation worsens autoimmune disease. This dysfunctional inflammation can attack any part of the body, including the brain, joints, digestive tract, skin, and thyroid. Other lifestyle factors can also impact autoimmune disease including stress, a sedentary lifestyle, obesity, smoking, a lack of sleep, and a lack of nutrients and vitamins – especially vitamin D. Vitamin D acts more like an immune-modulatory hormone, able to curb infections, many cancers, and excessive inflammation. However, many people have low levels of the vitamin as we don’t spend enough time outdoors and exposed to sunshine. Sunscreen decreases the formation of vitamin D in our skin, so individuals might want to be outdoors for 20-30 minutes before applying it, unless you are very sensitive to sunburn. Infections, such as Epstein-Barr Virus (EBV) and Helicobacter pylori, have also been implicated in autoimmunity.⁶ Swift treatment of Helicobacter may even reverse or improve some autoimmune conditions, such as idiopathic thrombocytopenic purpura (ITP), if identified early enough.⁷ 

The immune system must first learn to discern what is normal and what is not normal, thus a possible threat, to each individual. Damaged tissues, such as damage due to excessive oxidative stress and inflammation, may expose parts of our cells that the immune system will react to and sometimes develop antibodies against. And modern life, unfortunately, provides too many causes of inflammation and oxidative stress, including environmental pollution. 

Air pollution, pesticides – specifically the herbicide glyphosate – as well as heavy metals (lead and mercury), plastics (such as bisphenol A), adjuvants (such as aluminum), and many other toxicants have been linked to autoimmunity.

Environmental toxins attach to our cells and make them look like strangers to the immune system. The immune system does its proper job and attacks the “stranger,” inadvertently damaging our own tissues in the process. Environmental pollution is an ongoing problem that we need to address as a society, or we will keep suffering the consequences. 

Testing can help doctors and patients identify potential imbalances as well as markers of autoimmunity years before developing symptoms. Identifying potential imbalances in the pre-symptomatic stage allows doctors and patients to act to decrease the chance of developing disease, or at least postpone it into the more distant future. There is nothing to lose and only better health and energy to gain by cleaning up our diet, optimizing vitamin D levels, improving the gut microbiome, and getting toxins out of our lives. 

References: 

1. Genentech. (2017, November 1). Autoimmune disease 101. Genentech: Breakthrough science. One moment, one day, one person at a time. Retrieved July 21, 2022, from https://www.gene.com/stories/autoimmune-disease-101
2. Disease information. Autoimmune Association. (2021, September 30). Retrieved July 21, 2022, from https://autoimmune.org/disease-information/ 
3. Walsh SJ, Rau LM. Autoimmune diseases: a leading cause of death among young and middle-aged women in the United States. Am J Public Health. 2000 Sep;90(9):1463-6. doi: 10.2105/ajph.90.9.1463. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447637/ PMID: 10983209; PMCID: PMC1447637.
4. Mazzucca, C. B., Raineri, D., Cappellano, G., & Chiocchetti, A. (2021). How to Tackle the Relationship between Autoimmune Diseases and Diet: Well Begun Is Half-Done. Nutrients, 13(11), 3956. https://doi.org/10.3390/nu13113956 
5. What is celiac disease? Celiac Disease Foundation. (n.d.). Retrieved July 21, 2022, from https://celiac.org/about-celiac-disease/what-is-celiac-disease/# 
6. Smyk, D. S., Koutsoumpas, A. L., Mytilinaiou, M. G., Rigopoulou, E. I., Sakkas, L. I., & Bogdanos, D. P. (2014). Helicobacter pylori and autoimmune disease: cause or bystander. World journal of gastroenterology, 20(3), 613–629. https://doi.org/10.3748/wjg.v20.i3.613
7. Kim, B. J., Kim, H. S., Jang, H. J., & Kim, J. H. (2018). Helicobacter pylori Eradication in Idiopathic Thrombocytopenic Purpura: A Meta-Analysis of Randomized Trials. Gastroenterology research and practice, 2018, 6090878. https://doi.org/10.1155/2018/6090878