Over the years, we’ve observed common trends in patients with lupus and autoimmunity and have identified eight common underlying dysfunctions that tend to lead to the overactivation of the immune system and trigger and perpetuate the disease process. These eight issues shown below each play a role in regulating the immune system and need to be evaluated in every person suffering from an autoimmune disease.
Our guts are made to be “leaky” to some degree. The gastrointestinal system, the long tube that makes up our digestive tract, is an important barrier that separates us from the outside world and what we’re exposed to daily. This “tube” is made up of cells that create a wall to keep things from getting into the bloodstream. Cells are connected with tight junctions that fit together like puzzle pieces. When food particles are broken down into small enough particles, they can be absorbed through the cells and cell junctions and get into the bloodstream. There they circulate to reach the cells that need them. The junctions are small enough that larger particles, like undigested food and bacteria, can’t get through to get into circulation. This protects us from exposure to harmful substances and only allows in things that will benefit us.
Sometimes this vital barrier is breached allowing things like undigested food, chemicals, and bacteria to get into our bloodstream. This is called increased intestinal permeability, or “leaky gut.” The gut barrier is home to about 80 percent of our immune system. Its job is to identify foreign, potentially harmful invaders and fight them off before they can make us sick or cause harm. With leaky gut and invaders getting through the barrier, the immune system is put on high alert and ramps up our defenses. This “upregulation” of the immune system from leaky gut is a common underlying cause in creating an abnormal immune response in the body and a major cause of autoimmunity.
The food you eat daily may be contributing to your symptoms and upregulating your immune system. Food sensitivities are your immune system’s aberrant response to a non-harmful substance. This creates inflammation and can further perpetuate leaky gut, leading to an increased risk of developing more food reactions.
For example, when you eat broccoli, it has to be broken down and digested into small nutrients for your body to absorb and benefit from it. When your gut barrier is unhealthy or “leaky,” undigested food particles can sometimes get through the gut wall and into the bloodstream before they are completely broken down. Since your immune system isn’t normally exposed to large undigested food particles, it can easily mistake this large undigested piece of broccoli for something that isn’t supposed to be there and treat it more like a bacterium than a piece of food. This mistaken identity can cause your immune system to attack the broccoli and upregulate the rest of your immune system to be on high alert to look for anything else that looks like that “harmful” piece of broccoli.
When your immune system identifies something as harmful, your body makes “memory cells” (immunoglobulins or antibodies) that remember what it looks like so if you get exposed to it again, it will remember that it is bad and attack it before it can make you sick. This is how vaccines work. If you inject a virus into your bloodstream, you’re causing your immune system to make antibodies to remember how to fight off this virus if you get exposed to it in the future.
Of course, broccoli isn’t bad for you, but if your immune system makes antibodies to it, every time you eat broccoli, you risk triggering inflammation and possibly an autoimmune reaction. This abnormal reaction to food can be a root cause of triggering autoimmunity because certain foods, when not properly digested, look similar enough to some of your cells or tissues in your body and therefore can cause a case of mistaken identity with your immune system. For example, with exposure to gluten, the protein in wheat looks similar enough to some of the tissues in your body like the thyroid gland that it can cause your immune system to mistakenly attack your thyroid. This phenomenon is called molecular mimicry and can be a root cause of food triggering or perpetuating autoimmunity.
Infections aren’t always the typical head cold or flu symptoms like stuffy nose, sore throat, fever, nausea, etc. Some infections are more silent and chronic and don’t have obvious symptoms. Different categories of chronic infections include things like viruses (Epstein-Barr that causes mono and chronic fatigue), hepatitis, and Lyme disease that live in the body and can be dormant for years without active symptoms. There are also bacterial infections that change the bacteria in our guts or our microbiomes like H. pylori, C. diff, and yeast infections, such as candida. Parasites can also sometimes be found in places like the gut and cause infection. A lot of these “gut infections” don’t present with the typical signs like fever and nausea but rather can play an important role in upregulating the immune system in the gut and activating or perpetuating autoimmunity. Chronic infections can also wear down the immune system over time.
People with lupus tend to have higher levels of antibodies to some viruses compared to people without lupus. Some of the most common viral infections connected to lupus include Epstein-Barr virus (EBV), cytomegalovirus (CMV), parvovirus, and herpes virus. Parvovirus can cause symptoms very similar to lupus but will go away over time.
Dormant (asymptomatic/inactive) viruses survive in the body stored in body tissues. This is one possible reason why certain body tissues may be more attacked by the immune system than others. This could be one reason some people have certain symptoms such as arthritis if there are foreign bodies or viruses in the joint tissues.
One of the most important factors in controlling health comes down to having the right ingredients. Just like you need to have the right ingredients when making a cake, our bodies need the proper ingredients to heal and be healthy. Our bodies come equipped with an innate capacity to heal. If you scrape your knee or get a paper cut, your body innately knows how to heal the wound, and eventually, it will disappear. Our bodies are very intelligent in healing but need the right tools to do so.
Nutrient deficiencies can come from simply not eating enough nutrient-rich foods, which is why a proper diet is extremely important. But they can also come from poor digestion. If you are not able to digest and absorb the nutrients from your food, it doesn’t matter how well you are eating. To have a good nutrient status, you need to not only consume the right foods but ensure that your gut is healthy and processing things appropriately.
Vitamin D is arguably the most important vitamin (also considered a pro-hormone) for immune system balance. Most people are deficient and do not get enough vitamin D from their diet or lifestyle to help support the very important role it plays when it comes to health.
Toxins and Chemicals
The average woman applies roughly 200–500 chemicals to her body before she even walks out the door each day! Think about it – shampoo, conditioner, body wash, lotions, makeup, deodorant, nail polish, and hair products. But what effect do all these chemicals have on our bodies? Many of the chemicals we apply to our bodies get absorbed through our skin. This leads to a huge amount of chemical exposure to our immune system. Remember, our skin is one of our largest organs and a barrier system, just like our gut, that is meant to keep things out of our bodies, and it is a place where our immune systems are constantly surveying and protecting us from the outside world. This constant exposure to a plethora of man-made substances keeps our immune systems on high alert as they try to protect us from any external dangers we encounter.
Stress is potentially the most important factor when talking about health. But what is stress? Stress refers to our body’s response to its environment and comes in many forms: physical (like a fall or a trauma), chemical (such as toxins, foods, excess hormones), and mental/emotional (such as things we deal with daily — deadlines, timelines, relationships). Not all stress is bad; it is simply the way our body deals with all the things it encounters on a daily basis.
Let’s say a tiger jumped out from behind you right now. A healthy stress response would be to jump up and try to run away. Stress guides our body’s safety mechanisms and tells our body what to do for survival. But what if that stress we are talking about is a bee sting or a traffic jam on your way to work? Your body perceives stress as stress no matter the cause. So, whether or not you are being chased by a tiger or reacting to a food you ate, your body goes into survival mode and releases stress hormones to try to “save” you. One of the major stress hormones is cortisol, a hormone produced by the adrenal glands. If not functioning correctly, your adrenal glands can negatively affect the immune system and functions in the body that are tied to cortisol, such as the sleep/wake cycle, blood sugar control, and energy. Too much cortisol causes leaky gut and negatively impacts the conversion of other hormones. For example, too much cortisol can block the production and conversion of the thyroid hormone, the hormone that controls cell metabolism. Cortisol is also a fat-storing hormone and is commonly a cause of belly fat and weight gain.
Insulin and Blood Sugar
Sometimes seemingly “simple” problems such as blood sugar issues—hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), prediabetes, diabetes, and insulin resistance—can cause massive problems under the surface and cause your health to fail at a cellular level. In autoimmunity blood sugar issues, such as insulin resistance (when your cells no longer respond to the hormone insulin to allow sugar into the cell), are often at the root of dysfunction and inflammation in the body. When glucose (sugar) can’t get into the cell due to something like insulin resistance, the cell cannot produce ATP (cellular energy) and, therefore, can’t work as efficiently. Just like your car won’t go if it runs out of gas, all cell function suffers if your cells can’t produce ATP. This is why one of the foundations of healthy cell function is proper blood sugar control and insulin sensitivity.
When this foundation is dysfunctional, it affects all your cells, leading to system-wide problems. One danger with insulin resistance is that it is “silent.” It is the main mechanism behind diabetes and prediabetes, and yet even people with a “normal” A1c (the marker used to test for diabetes) can have insulin resistance and not know it. It is estimated that over half the population in the US has either diabetes or prediabetes, and yet a majority of those have no idea and remain undiagnosed.
Why is autoimmune disease more prevalent in women than men? While several factors, including genetics, affect this, the answer may have to do with the hormone estrogen. Estrogen, just like insulin, is an inflammatory hormone. And even though both men and women produce estrogen, women make a lot more of it and have way more fluctuations with their hormones, especially at different times in their life. It is not uncommon to see autoimmune problems develop at times when the hormones are fluctuating the most: puberty, pregnancy, post-pregnancy, menopause, and perimenopause.
Estrogen surges or estrogen dominance (an imbalance between estrogen and progesterone) can be the perfect inflammatory response to trigger your immune system to be on guard. Too much estrogen can stem from several reasons, such as an overproduction (from things like uterine fibroids) or poor detox and clearance of estrogen.
A majority of women who develop lupus do so in their childbearing years (from puberty to menopause). It is also not uncommon for symptoms of lupus to increase or worsen around their monthly cycle as the hormones fluctuate.