Autoimmune Disease: A functional approach
One of the reasons that I love functional medicine is because of the hope that it offers many people who have been given a diagnosis without a reason as to why they have developed this disease or a means to better understand how to heal from it. Although there are some people who would just like to take a pill to squelch their symptoms and go about their daily life, there are many more who would prefer to understand where those symptoms are coming from and how to get rid of them for good. Most people really don’t want to be on medication forever. Coming from an allopathic background as a nurse, I certainly understand the need for and greatly appreciate modern medicine for acute and emergent illnesses. In my opinion, however, it is in the management of chronic illness that conventional medicine falls short. Let me explain what I mean, and bear with me as I nerd-out a bit. The science is absolutely fascinating, so hang with me.
Functional medicine is a more comprehensive and integrated approach to discovering the cause behind the illness, rather than just grouping symptoms to name a disease and matching the corresponding drugs to that name. Conventional medicine has become segregated and specific, each organ system has its own medical specialist and many doctors have forgotten how to approach the body as an intricately designed whole. Even the most well-intentioned conventional doctors often are pressed for time due to insurance constraints and simply cannot devote the time and attention to their patients to dig deeper into their illness, and as such more time is spent reactively “fixing” acute illness rather than preventative medicine. Conventional medicine seeks to group like symptoms into a neat little box called a “diagnosis” to then prescribe their corresponding drugs like Band-Aids.
Functional medicine is concerned with why a disease is occurring in the first place, and focuses on healing the body by identifying and eliminating common triggers for disease (i.e., inflammation), and supplementing the body with common vitamins and nutrients that allow it to function optimally (1,2). Many functional practitioners do not use insurance and are thus free to spend ample time with their patients to discover the root cause of their illness and teach more effective measures of prevention.
Autoimmune disease is a great example of the differences between conventional and functional medicine. The immune system is the body’s method to identify self from non-self and the mechanism with which it uses antigens to destroy or neutralize foreign invaders. The immune system is comprised of the lymphocytes (B and T cells), thymus, spleen, bone marrow, lymph nodes, tonsils, adenoids, appendix, lymphatic vessels, liver, and Peyer’s patches in the small intestine (3). These organs and their cells amass an army of protection whenever foreign substances threaten homeostasis, but their effectiveness can become compromised by issues such as chronic maldigestion, malabsorption, leaky gut, intestinal dysbiosis, problems with elimination, liver dysfunction, heavy metals and toxins, medications, stress hormones, and poor diet. This helps to explain why someone with a chronically toxic body is more susceptible to autoimmune diseases in which the immune cells mistakenly attack the body’s own tissues (3).
Conventional medicine chooses to suppress the body’s natural immune response, inhibiting normal physiology and covering up underlying inflammation with steroids to manage symptoms. Functional medicine looks deeper to understand why the body has reacted in such a way and seeks to eliminate multiple factors that are perpetuating the state of toxicity and ensuing cellular chaos. If the triggers are dietary, then functional medicine encourages dietary interventions and correcting nutritional deficiencies. If the triggers are toxins, then the focus becomes identifying and avoiding the source and improving elimination (3).
One of my favorite approaches to autoimmune conditions is Autoimmune Paleo (AIP) Protocol—a combined dietary and lifestyle approach to the management of chronic autoimmune disease that is focused on providing the body with the nutritional resources required for a healing the gut, regulating hormones, providing a healthy immune response, and supporting tissue healing while concurrently removing inflammatory stimuli from both diet and lifestyle. The AIP diet provides balanced and complete nutrition while avoiding processed foods and empty calories. One of the things I love most about AIP is that just as much emphasis is placed on the inclusion of nutrient-dense foods as the avoidance of lesser quality ones.
Okay guys, here’s where it gets fun. Much is still being discovered about the genetic and environmental etiology and triggers of autoimmune disease, and one of the more recent and well-established mechanisms is that of vitamin D insufficiency and altered intestinal permeability, or leaky gut (4). Vitamin D plays an important role in increasing innate immunity while concurrently modulating adaptive immunity through the signaling of vitamin D receptors (VDR). Key immune cells (macrophages, dendridic cells, T and B cells) all express the vitamin D receptor (VDR) and can produce bioactive 1, 25(OH)2D3 (5). Vitamin D insufficiency has been correlated to an increased prevalence of autoimmune diseases such as multiple sclerosis, SLE, rheumatoid arthritis, and inflammatory bowel diseases such as Crohns and ulcerative colitis (4,5). VDR agonists have been studied for their anti-inflammatory, antibacterial, immune-boosting, tumor cell and vessel growth-inhibiting, properties that aid in the treatment of various autoimmune diseases (5). One study of over 10,000 children followed from birth to over 30 years found that participants who regularly supplemented their diet with just 2,000 IU of vitamin D per day were 80% less likely to develop type I diabetes compared with those who supplemented less or none at all (6). Supplemental vitamin D has also been found to help regulate some of the monocyte (a type of white blood cell) abnormalities in patients with type I diabetes, as an increase in specific toll-like receptors (TLRs) linked with inflammatory markers on monocytes has been discovered in type I diabetics (4). As researchers have now found an inflammatory component to the development of type I diabetes, this further proves the worth of functional medicine and its ability to identify triggers of inflammation and eliminate them.
If I lost you there, just know that when used as an adjunctive therapy with the elimination of inflammatory triggers and other causes of autoimmune disease, vitamin D supplementation offers incredible benefits for this population. People with autoimmune diseases who have been treated by conventional methods present a unique opportunity for functional medicine to offer hope where there has likely been little to none. Autoimmune diseases are typically seen as incurable, lifelong illnesses that one must simply learn to cope with as best as possible, but this is simply not the case. By employing the functional tools discussed above to identify the root cause of their disease and addressing that cause, these people can and will see their body slowly begin to heal. The AIP protocol and vitamin D are just two examples of many tools that will be beneficial in future practice to help boost the natural immunity and restore health in autoimmune diseases.
1. Hyman M. About functional medicine [video]. http://drhyman.com/about-2/about-functional-medicine/
2. What is functional medicine? The Institute of Functional Medicine. Updated 2016. Accessed March 10 2020. https://www.functionalmedicine.org/about/whatisfm/
3. Boroch A. The Candida Cure: Yeast, Fungus, and Your Health. Quintessential Healing Publishing; 2009.
4. Pizzorno JE, Katzinger J. Clinical Pathophysiology: A Functional Perspective. Coquitlam, BC Canada: Mind Publishing Inc; 2012.
5. Adorini L, Penna G. Control of autoimmune diseases by the vitamin D endocrine system. Nat Clin Pract Rheumatol. 2008;4(8):404-12. doi:10.1038/ ncprheum0855.
6. Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. The Lancet. 2001; 358(9292), 1500-1503. Accessed March 10 2020. http://housemajority.org/ seaton/pdfs/27/5448201.pdf