Yes, You Have Autoimmunity. But Is It Really Caused By Leaky Gut?
Over and over again, autoimmunity patients arrive at our clinic for the first time with stories of frustration. There are two reasons for their frustration. First, their doctor ordered tests, but when the results came back, they were told everything was normal and they were perfectly fine. Yet, they didn’t feel fine. And when I look at their test results, I realize the practitioner only ordered the bare minimum of testing. The clinician was missing out on important information. For example, to determine blood sugar levels, many practitioners only order fasting glucose. But there are other tests needed to fully understand a person’s sugar metabolism. Another example? A clinician orders only a thyroid-stimulating hormone (TSH) level, but no other thyroid health markers to go along with it.
Have You Been on a Wild Goose Chase?
A second reason for frustration is some patients have been tested excessively and they aren’t getting better with treatment. That’s often because they (and their healthcare team) still don’t know what is actually contributing to their autoimmune disease. When clinicians run a large number of tests on patients, it can be information overload. The findings may lead to elaborate treatments, but they may not be relevant to the patient’s specific problems. It’s like going on a wild goose chase. A good example of this is Epstein-Barr virus (EBV). Nearly everyone is going to test positive for EBV IgG since nearly everyone has been exposed to this virus, but that doesn’t mean it’s the culprit behind every patient’s autoimmune disease. A focused panel of testing should be ordered based on a person’s history and his or her chief complaints.
It’s easy for both doctors and patients to assume that everyone with autoimmune problems has the same root cause and trigger. This leads to each patient treated and tested in exactly the same way. Yet, each patient is an individual. Not every autoimmune disease patient with the same diagnosis, condition, or symptoms will have the same root problems as their main focus to treat.
Guess What? It’s Not All About Leaky Gut
When it comes to autoimmune disease, there is a lot of hype about leaky gut syndrome, or intestinal permeability. This is where the intestinal lining becomes thin and allows undigested food particles and pathogens to escape into the bloodstream.
The hype about leaky gut is not without reason. It can be a major problem for people with autoimmune disease. But it is NOT the root cause for all patients with autoimmune disease. Not all autoimmune patients need to be tested for leaky gut—nor do they need leaky gut repair. For some patients, the root cause of autoimmune issues is chemical or toxin exposure. For others, the trigger is stress or blood sugar imbalance. You can read more about the 9 Root Causes of Autoimmune Disorders here. The only way to uncover the root cause of a patient’s problems is to perform a thorough health history and order the right testing.
Going Back to Basics
The same thing happens with parasites, Candida, and Hashimoto’s, lupus, or other autoimmune conditions. Many patients have heard that parasites and Candida can cause autoimmune problems. Consequently, they want to be tested and/or treated for those conditions. However, we can’t rush in to testing for parasites or Candida until we order basic blood work that tells us about foundational imbalances. Sometimes, just addressing low vitamin D levels or getting rid of insulin resistance clears up all of a patient’s problems. It’s important to narrow down the problem and not chase after every possible theoretical cause of a patient’s health issues. Otherwise, you’re running in circles.
When we start by looking for foundational imbalances, we’re not chasing 20 different factors right off the bat and we can narrow our focus. This leads to a high success rate in treating autoimmune patients. It also makes better use of your important resources like money, time, and the effort it takes to change your lifestyle.
Zooming in on Autoimmune Testing
Perhaps you are wondering: What tests really do need to be run on someone with an autoimmune disorder? The first step is to look at the personal health history of the patient. I talk to them about their experiences and symptoms and ask them to remember when their problems may have started. That way, I can develop a timeline of their autoimmunity issues and pinpoint the factors that may have triggered the patient’s downturn.
For most patients I then order a thorough blood panel to rule out foundational health problems such as vitamin deficiencies or blood sugar problems. Sometimes just fixing those very basic things can cause everything else in the body to work better. It takes the total stress load of the body down a notch so that the immune system isn’t so overactive.
My Initial Bloodwork Panel to Look for Foundational Imbalances in Autoimmunity
I always tailor this list based on the patient’s health history and symptoms.
• Complete blood count (CBC) with differential and platelets
• Comprehensive metabolic panel (CMP)
• Vitamin D
• Gamma glutamyl transferase (GGT)
• Phosphate (as phosphorus)
• Uric acid
• Total iron binding capacity and saturation
• Fibrinogen activity
• Inflammatory markers like C-reactive protein (CRP) and homocysteine
• Lipid panel
• Testing for blood sugar issues beyond the usual glucose testing. I also check for hemoglobin A1c, insulin, c-peptide, and lactate dehydrogenase. Low levels of the enzyme lactate dehydrogenase may indicate a patient has reactive hypoglycemia, where blood sugar doesn’t stay stable. Instead, it crashes a lot and causes insulin surges.
• Serum magnesium
• Thyroid panel. At first, I’ll order TSH, T4, T3, Free T3, T3 uptake, and Free T4. If there are abnormalities in those thyroid hormones or if a person has a family history of thyroid diseases, then I may add a test for thyroid antibodies, high levels of which indicate a patient has Hashimoto’s. If the patient has symptoms or testing is abnormal, I might also add other thyroid testing such as reverse T3.
Once patients have had this blood panel and taken steps to address any foundational problems that showed up, I can build on the results. At that point, we may isolate things further by selecting specific testing that may include looking at salivary cortisol levels, a comprehensive stool analysis, a small intestinal bacterial overgrowth (SIBO) test, toxin panels (heavy metal, glyphosate, mold, non-heavy metal chemicals), viral or bacterial pathogens (Lyme, Epstein Barr Virus, etc.), immune lymphocyte panel, or hormones, depending on the patient’s symptoms and history.
A More Focused Approach to Healing
Leaky gut is a real issue, but it is not the root cause for everyone with autoimmune disease. Don’t get lost on a wild goose chase while your autoimmune condition gets worse. Knowing which tests to order and which factors to treat is a clinical skill I’ve developed over time. As a functional medicine provider with a focus on autoimmune disease, I can help you get at the real root cause of your problems. Schedule a complimentary virtual appointment with us to pinpoint the cause of your autoimmunity and get on the road to recovery. You’ll feel less frustrated about your health and find real solutions. Get ready to have more energy and get your life back.