Any disease condition is a continuum. This means that you do not move from being well to having a disease overnight. Just as in Type 2 Diabetes, where you may have dysregulated blood sugar levels (Dysglycemia) many years before you develop the disease, so it is with many autoimmune conditions. You may have autoantibodies in your blood many years before developing the disease. Despite recent advances in treatment, there is a large percentage of people in whom long-term remission of the autoimmune disease cannot be achieved. This leads to poor quality of life and sometimes an early death. As this oft-quoted Benjamin Franklin axiom says “an ounce of prevention is worth a pound of cure”. Several scientific studies in the last few years have shown that you may have tell-tale evidence in your body 5-14 years before developing an autoimmune disease. An autoimmune condition develops when there is an interaction between your genes, an environmental trigger, your immune system and intestinal permeability. Your genes are present from birth but you do not develop an autoimmune disease until later. So what happens? In any autoimmune disease like it is in any other disease, it is an interaction between your genes and the environment that decides your health. As Dr. Eric Topol, a world-renowned cardiologist, geneticist, digital health pioneer, and medical innovator, says,“healthy aging is 100 percent due to genetics and 100 percent due to your environment”.
Autoimmune conditions develop when your immune system makes antibodies against your own tissue ( Autoimmunity). This can lead to your healthy tissue losing their ability to function normally. For example, in Type 1 Diabetes, your own body makes antibodies against your own pancreatic cells which produce insulin. Insulin is the hormone that keeps your blood sugar in balance. The other, commoner diabetes is Type 2 Diabetes, in which antibodies to pancreatic tissue is not usually present. (Incidentally, these autoantibodies to pancreatic tissue have been found in about 5% of people otherwise diagnosed as Type 2 Diabetes.Watch for post on LADA , Latent Autoimmune Diabetes of the Adult).
In fact, a new staging approach is being used in Type 1 Diabetes taking into consideration the number of autoantibodies present. The staging starts well before the disease develops. This approach is used to prevent or delay the onset of the disease. Perhaps you can start prevention in your child when you are pregnant! Studies have shown the connection between vitamin D deficiency in mothers and autoimmunity in children.
Rheumatoid Arthritis (RA): RA is an autoimmune disease affecting joints, which is characterized by chronic inflammation, causing pain and stiffness in the joints and a poor quality of life. Half of the patients with RA already have X-ray evidence of joint damage at the time of diagnosis. Like most diseases, RA can be treated better if diagnosed early. Therefore, the ability to predict the disease before joint damage occurs will contribute to a better quality of life.
WHO SHOULD BE TESTED FOR AUTOANTIBODIES?
- Anyone who has a diagnosed autoimmune condition. Studies have shown that if you have one autoimmune disease, the chances of your developing another one are much higher than in the general population.
- To test for disease progression in people with autoimmune diseases.
- Anyone with hypothyroidism who has never been tested for thyroid antibodies.
- First degree relatives (a person’s parent, sibling or child) of people with an autoimmune condition.
- Patients with painful and stiff joints who haven’t received a definitive diagnosis of RA yet.
- Anyone interested in better health.
WHAT TESTS SHOULD YOU DO?
A complete workup is very important. However, the following must be included.
- C-Reactive Protein: This is a marker of inflammation.
- Vitamin D3 levels: Vitamin D has a major role in your immune system. Low levels of this vitamin have been associated with increased risk of autoimmune diseases. (Vitamin D)
- Antibodies: This list increases by the day. There are some specialized tests available in some countries which I have not listed here. (For those of you interested in the detailed medical information, please read the article in Autoimmunity reviews6 (2015) Damoiseaux, Jan, et al.).
This table has a short list:
|ANA||Lupus, Scleroderma, Autoimmune Hepatitis, Sjogren’s Disease, Polymyositis, Dermatomyositis, Mixed Connective Tissue Disease, Juvenile Arthritis, Drug-induced Lupus.|
|Anti-Cyclic Citrullinated Peptide (Anti CCP)||Rheumatoid Arthritis|
|Anti TPO & Anti Thyroglobulin||Hashimoto’s Thyroiditis|
|Anti TSH Receptor||Graves’ Disease|
|Anti-tissue transglutaminase (tTG) antibodies
Endomysial antibodies (EMA)
Deamidated gliadin peptide (DGP) antibodies
(IgA & IgG tests)
|Islet Cell Cytoplasmic Autoantibodies (ICA) & Glutamic Acid Decarboxylase Autoantibodies (GADA)||Type 1 Diabetes, Late Autoimmune Diabetes of the Adult(LADA).|
WHAT IS THE DIFFERENT ABOUT THE FUNCTIONAL AND METABOLIC MEDICINE APPROACH?
Fig 1: Functional & Metabolic Medicine approach versus Conventional Approach:Fork in the road.
WHAT SHOULD YOU DO?
- Meet a practitioner who understands the Functional & Metabolic Medicine approach to autoimmunity. There are no pharmaceutical drugs that can be used to prevent autoimmune diseases before they develop.
- Stop smoking (Easier said than done!). Exposure to cigarette smoke has been associated with higher risk of Rheumatoid Arthritis in those susceptible to it.
- Reduce toxic exposure.
- Reduce inflammation.
- Manage stress.
- Maintain adequate Vitamin D3 levels (Vitamin D)
- Avouac, Jérôme, Laure Gossec, and Maxime Dougados. “Diagnostic and predictive value of anti-cyclic citrullinated protein antibodies in rheumatoid arthritis: a systematic literature review.” Annals of the rheumatic diseases7 (2006): 845-851.
- Catrina, Anca I., et al. “Lungs, joints and immunity against citrullinated proteins in rheumatoid arthritis.” Nature Reviews Rheumatology 11 (2014): 645-653.
- Damoiseaux, Jan, et al. “Autoantibodies 2015: From diagnostic biomarkers toward prediction, prognosis and prevention.” Autoimmunity reviews6 (2015): 555-563.
- Nielen, Markus MJ, et al. “Increased levels of C‐reactive protein in serum from blood donors before the onset of rheumatoid arthritis.” Arthritis & Rheumatism 8 (2004): 2423-2427.
- Notkins, Abner Louis. “New predictors of disease.” Scientific American3 (2007): 72-79.