Autoimmune disease is on the rise. A study of 22 million people found autoimmune disorders now affect around one in 10 individuals, with women more affected than men.
Dr. Aristo Vojdani, a leading functional immunologist, coined the term “environmentally induced autoimmunity” to highlight that autoimmunity is not just mediated by genetics—or what medicine has termed “idiopathic” causes. Rather, autoimmune diseases are dramatically increasing in many parts of the world, likely due to changes in our exposure to environmental factors.
Environmental Factors and the Immune System
Current evidence implicates the widespread use of antibiotics, food engineering, ultra-processed food and xenobiotics in microbiome alterations, due in part to the presence of immune tissue in much of the gut. In addition, increased rates of autoimmunity may be caused by sensitization to food antigens, air pollution, infections, personal lifestyle choices, stress and climate change.
How to Assess Autoimmune Disorders in Your Patients
As patients come to you with a wide array of sometimes non-specific complaints, it is important to understand that autoimmune disease exists as a spectrum, and you may meet them anywhere along that spectrum. Obviously, the sooner you get to help them, the better.
We have known for years that patients with a positive antinuclear antibody (ANA) can develop lupus decades later. So, anytime you see inexplicable joint pain, unusual gut symptoms or atypical skin rashes, start thinking about an autoimmune etiology. The good news is that, from a functional medicine perspective, there is a lot you can do.
Conventional Medicine Workup
Initially, work a patient up thoroughly by pursuing a conventional medicine diagnosis. If it is positive, I like them to see a rheumatologist or immunologist to discuss the various medical options available and their side effects.
This serves two purposes: first, it allows patients to understand what a conventional medicine approach can provide, especially if their disease is severe. But second, and more often than not, they find their conventional options are limited.
Functional Medicine Workup
The next step I take is to perform a functional medicine workup. During the workup, I aim to discover the following:
- Is there a possible genetic link? Did a family member have an autoimmune disease?
- What gut symptoms do they have? Were they breastfed or bottle-fed? Did they undergo multiple courses of antibiotics during childhood? What is or was their diet like?
- What is their exposome? Were they exposed to chemicals, pesticides or insecticides? Do they work with or near chemicals, or are they exposed to fumes or gases?
- Do they have any history of adverse childhood events, emotional or physical traumas, or ongoing emotional toxicity that may be causing their immune system to be in a constant state of hypervigilance? If so, this needs to be addressed.
- I want to know about potential triggers: What precipitated this illness? What was going on in their lives at the time it began? Did they have a viral illness? Could they have a tick-borne disease or mold exposure that results in CIRS (chronic inflammatory response syndrome)?
- Often, in the case of environmentally induced autoimmunity, the patient has a mast cell activation syndrome (MCAS) in addition to everything else. I look for this, too.
Testing for Autoimmunity
Then, if the patient can afford it, I do an extensive workup to look for leaky gut, food sensitivities and chemicals they may be reacting to. Cyrex Laboratories, a leading lab in this field, offers tests for chemical immune reactivity. They also have arrays for multiple autoimmune diseases and neurological reactivity.
If the patient cannot afford this, an elimination diet and a general detoxification protocol are worthwhile alternatives.
Functional Medicine Treatments for Autoimmune Disorders
Once this initial workup is complete, I begin teaching them to return to well-being. This means I need to empower them with the knowledge and tools to get better.
Here are some treatments to consider:
- I correct the disorder depending on what I find in each patient, which may include detoxification diets, fasting-mimicking diets, the 5R approach to gut rehabilitation, medications or supplements.
- Sometimes, low-dose naltrexone (LDN) can help calm down the immune system.
- I suggest integrative healing techniques, such as acupuncture, energy healing, massage or craniosacral therapy.
I also always emphasize the importance of making healthier lifestyle choices to reduce autoimmune symptoms and support overall health, such as:
- Adopting a well-balanced diet
- Engaging in regular exercise
- Getting adequate sleep
- Managing stress: High stress levels can trigger autoimmune flare-ups, so practicing stress-reducing techniques, such as meditation, deep breathing exercises, or engaging in hobbies, can be beneficial.
- Addressing emotional trauma: Sometimes, modalities such as EMDR (eye movement desensitization and reprocessing) can alleviate emotional trauma.
- Seeking support: Connecting with support groups or individuals experiencing similar autoimmune conditions can provide emotional support and helpful tips for managing symptoms.
Returning Your Patients to Well-Being
In our practice, it’s not uncommon for rheumatoid factors, ANA results or antithyroid antibodies to once again become negative. It is gratifying to watch patients get off medication and resume the life they longed for while struggling with autoimmunity.
It’s important to note that the management of autoimmune diseases should always be personalized, and these strategies may vary based on specific conditions and individual needs. In our practice, we try to build a health care team for the patient because we find this is crucial for creating an effective and tailored plan for transforming autoimmunity into well-being.
Steve Amoils, MD is the Co-Medical Director of the Alliance Integrative Medicine (AIM) in Cincinnati, together with his wife Sandi Amoils, MD. He is an Adjunct Assistant Professor in the Department of Medical Education at the University of Cincinnati and President of the Ohio Chapter of the American Academy of Medical Acupuncture, and has been practicing Functional Medicine since 2000. He has received numerous awards for his achievements, including America’s Top Doctor in Family Medicine and Cincy Top Doctor yearly since 2007.
Trained in South Africa, London and then in the United States, Steve is a board-certified family physician. After completing medical training in South Africa in 1984, he and Sandi spent two years traveling around the world, studying various indigenous medical systems. In 1987, they immigrated to the US, where they ultimately both practiced as family physicians in Cincinnati. In 1999, at the behest of a large hospital group, they opened Alliance Integrative Medicine to offer patients a comprehensive, personalized, integrative approach to medicine. AIM has been recognized nationally as a leading center in integrative medicine since 2004, and Dr. Amoils has been a site investigator on three major national studies on integrative medicine. AIM averages approximately 30,000 patient visits per year. Alliance Integrative Medicine offers an accredited physician fellowship training program in integrative medicine.
Through the nonprofit Integrative Medicine Foundation, the Amoils are active in research, education and overseeing the Get Well program for the underserved. Steve and Sandi are co-authors of Get Well & Stay Well – Optimal Health through Transformational Medicine. The book expounds on their philosophy of helping patients transform illness into wellness through the best of conventional medicine, functional medicine and integrative therapeutic options