Dr. Paul Anderson explains autoimmunity, a condition where the immune system attacks the body's own tissues. It now affects 23-24 million Americans, surpassing cancer. He covers genetic factors, environmental triggers like infections and diet, standard drugs like methotrexate and TNF inhibitors, and integrative approaches targeting root causes.
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By tuning into Contact Talk Radio and on TuneIn.com, Ping.fm, and UpSnap Mobile. Contact Talk Radio. Welcome to Medicine and Health with Dr. Paul Anderson. This is a show about opening up the often mysterious world of how doctors think. The goal: to empower the listener to gain access to the best healthcare possible. Good day and welcome to Medicine and Health. I'm Dr. Paul, and today our topic is autoimmunity. It's got a lot of questions about autoimmunity. Don't know if we're going to get to all of the questions because, as I do sometimes, I put out the question on social media and we got a lot of responses. So we're going to do our best, but we may break this up and do a couple of these. Autoimmunity is very common, and it is something that a lot of people struggle with. A lot of families have people with autoimmunity, and it's a good topic to kind of dive into. So what I'm going to do today, which is a little bit of a new sort of format, but I think it'll help out a little bit with the organization, is I'm going to put this into 4 Chunks. And so we'll have a little transition between each of the 4 sections. And so we're going to talk about first, what is autoimmunity and what are the major diseases associated with autoimmunity, just in case you may have one or may not know what they are, et cetera. Then second section, we want to talk about what causes autoimmunity and how broadly the cause areas are that exist in humans and autoimmunity. And then the third and the fourth section, we want to talk about therapies or treatments. So the third section will be, uh, your standard medical-type therapies, which includes some older and then some very newer targeted therapies. A lot of the newer therapies you see ads for on TV, for example. And then in the fourth section, we want to talk about what are integrative approaches to autoimmunity. And what I have a feeling that we'll wind up doing probably is We'll do this in 4 sections today, and based on all of the questions that have come in in the last just 24 hours since I kind of put this out there, we may drill down into some of these other therapies a little bit more deeply. But here in the first section, where we want to talk about what is autoimmunity and what diseases are included, I just want to give you a flavor for how frequently autoimmunity comes up, how common it is, and all of that. Right now you may be listening live on CTR Radio Network. We're live streaming this to Facebook Live, and so that's going out there. And then later we'll put this up on YouTube. We'll also transfer it over to all of the Podburners. So if you listen on podcasts, thank you, or YouTube. If you're on a Podburner or YouTube, please like, share, subscribe, comment, all of those good things. Those are all very useful. And when I talk about, uh, the references that I include in a lot of these things, those won't be, uh, on, uh, the Facebook Live platform. They'll be over on the YouTube platform. So the audio platforms won't have references, but the YouTube platform will. All right. So one of the things I think that's important to think about with respect to autoimmunity and autoimmune diseases is that Autoimmune disease— and this will lead us into a bit of discussion around cause, potential causes, etc.— has grown at literally an alarming rate since, uh, the end of World War II. Now, there may or may not be anything to do with World War II proper as far as being a war and that timing, but basically, if you think about The time period after the war ended in the late 1940s and early 1950s until now, and you look at the statistics for autoimmunity and the frequency of autoimmune disease, it's, it's been an incredibly steep rise since then. So, you know, we're looking at roughly a 70-year period here. And so the first thing is that And we're not going to talk about all of these today, but there's about 80 autoimmune diseases. So that's a lot more than most people think exist. Now we'll get into what autoimmunity is, but have 80 diseases in one category, it must be a pretty big deal. But then the next thing to think about is, um, what is the prevalence of autoimmune disease? Well, the National Institutes of Health estimates it's around 23 to 24 million people people just in the U.S. So if you're listening from another country, your numbers are going to be different, but it's going to be a big number. But NIH thinks we have about 23 to 24 million people in the U.S. with autoimmune disease. And if you contrast that to cancer, right now cancer is affecting 13 to 14 million people in the United States. So if you think about the magnitude of the number of people who have cancer, second leading cause of death, uh, and then you think about the magnitude of the number of people who have autoimmunity being another, you know, 10 million or so higher, autoimmunity is an extremely common medical problem in the United States and really all around the world. But I think it bears some notice that autoimmunity is something that used to be a very much more rare type of a disease, although autoimmunity has been described in modern medical literature as far back as we have it, and we have descriptions of what appear to be autoimmune conditions prior. But the frequency of it going on is, is just incredibly higher now. So if we look at since 1950 till 2022, and we're talking Um, it's, it's almost a straight line, uh, you know, like a logarithmic line going up in, uh, increase. Now there are some other things about autoimmunity and the statistics and all that that we'll kind of get into here, but I wanted to start out with, well, okay, so autoimmunity, basically what is it? And then what are like the top let's say 15 or so diseases that are included in autoimmunity. So the first thing is, is that autoimmunity is just what it says, where your immune system, through one of many, many means— and your immune system has an almost unlimited number of ways to act, which is good. We want our immune system to protect us from infections and help us heal and all that. That's great. It has a lot of ways in. When you become autoimmune, what happens is one or a group of these means to triggering immunity get targeted against you instead of a bad guy, a foreign invader. Now, that sounds like an oversimplification, but really that's the crux of what autoimmunity is. Now, we can look deeply into the biology of the different autoimmune diseases, And what we find is different ones have different types of immune biology that create the disease. Hence, for example, rheumatoid arthritis having different disease state and different disease processes than multiple sclerosis or Crohn's disease. So they're all going to have different sort of, like I say, ways into the immune system being dysfunctional. And that leads us to different targets for the autoimmunity. So we'll talk a little bit about that, but the bottom line is, is that if you are dealing in the treatment side of things with something that is, say, a real targeted therapy like the modern biologic drugs, then knowing the exact places where the immune system goes wrong becomes very important, because if I'm putting a targeted drug into a person and I'm targeting the wrong place, it's not going to help that person's autoimmunity. On the other hand, if you are looking at it from a bigger picture point of view and trying to treat all of the underlying causes, then knowing the exact route through which the autoimmunity developed is helpful, but you're not really targeting just that route. You're targeting what triggered that route to become so aggressive or so well ingrained. Let's just talk real quick about some of the top autoimmune diseases. So in, in this group of 14 or 15 we're going to talk about are the top ones. I'll describe each one. Most of them you've probably heard of already, and they don't really go in any particular number order. Just think of out of all 80 diseases plus, these 14 or 15 are going to be your top ones, and that's why you've heard of them. First one is type 1 diabetes, so not type 2 diabetes, but type 1. And, uh, this is where you actually have an immune attack on the beta cells in your pancreas, and the beta cells release insulin. So if I'm attacking the beta cells in the pancreas, I'm not going to release insulin anymore. So in type 1 diabetes, you stop releasing insulin, and that can be very deadly, obviously. And so people with type 1 diabetes are generally given insulin as one of their primary therapies. Type 1 diabetes used to be known as juvenile onset diabetes because statistically more, you know, younger people develop type 1 diabetes than older people. Adult onset used to be known as type 2 diabetes. But now we know that you can develop the autoimmune picture of type 1 diabetes, you know, mostly in younger ages, but also as you age as well. So biggest thing with type 1 diabetes is you have a direct attack on the beta cells in your pancreas. Those are responsible for making insulin, and then you don't make much or any insulin anymore, so you need— outside insulin to help you with that. Now, one thing that you're going to see is that hormone-producing areas like the pancreas and insulin, for example, and we'll see the thyroid and some other places, are not an uncommon target for autoimmunity. That's because those are also common targets for some of the fuels to autoimmunity. We'll get to that in a bit. Next one I want to talk about is rheumatoid arthritis. So a lot of people think of arthritis, they think of osteoarthritis, which is more the wear and tear type arthritis where maybe you've injured joints in the past and then they, you know, they swell up on, you know, on cold mornings or it's sort of hard to get going in the morning and all that. Rheumatoid arthritis, on the other hand, is actually an autoimmune attack on areas that are very critical to your joints working. One of the areas that's very critical, it's a very dynamic area to your joint working, is the synovial membrane, which is inside of each joint. Each joint that moves has a synovial membrane so that the bones don't come together. So if you look at rheumatoid arthritis, you actually have attack inside of the synovial membranes that are supposed to be protecting and kind of feeding the joint. Okay, synovial membrane helps to produce some of the fluid that's in the joint. It helps to keep the flow of water in and out at a regulated level and does other immune things. So imagine if you've got that and then you start attacking that joint lining with these immune attacks that then create inflammation, you're gonna not only have inflammation but probably degeneration of the joints. So in rheumatoid arthritis, you often will see— not always, but you often will see paired bilateral joint problems. So it might— a person might complain of the wrists, both wrists first, or shoulders or elbows. And then it may move around. Later stage rheumatoid arthritis, you might actually see deformities, especially in the wrist and the hands. And it can be in other joints as well. So rheumatoid arthritis, Something to keep in mind as not the wear and tear arthritis we normally see as we age called osteoarthritis. This is actually your immune system targeting the very part of your joint that's supposed to keep the joint moving smoothly. So that's rheumatoid arthritis. Now, there are in type 1 diabetes, for example, we used to call it juvenile onset. That's because it mostly hits young people and is with them for the rest of their life. Well, with rheumatoid arthritis, there's sort of 2 categories. One is more of the common adult onset rheumatoid arthritis, and then the other is juvenile rheumatoid arthritis, which we'll talk a little bit about later in the treatment section. The next one is a combination of 2 things, one of which we think of as a skin disorder, but it's actually an autoimmune disorder that can be more than a skin problem, and that's psoriasis and then psoriatic arthritis. Psoriasis, if you've seen it or if you have it, is a thickening and a scaling-like of the skin. And what normally happens is that you're supposed to— so your skin has these strata where the outside cells are produced. So if you go down to the base at the basal lamina where you produce your skin cells, they work their way up. And then as they get thicker, they get keratinized, which is a type of material. That fills up the skin cells so that we have a waterproof surface on our skin and we don't get bacteria and stuff in there. Well, what happens in psoriasis is that the area that creates the skin cells is essentially attacked biochemically in the autoimmune arena. And so instead of turning over, you know, a new batch of cells every about a month, you're turning them over much, much more quickly, just a few days. So if you can imagine, instead of pumping out enough cells to keep your normal thickness of skin, and you multiply that by a factor of, you know, 5 or 6 or 7, you're going to have a lot of this, the keratinized cells on the top that just keeps stacking up. That's where the plaques come from, the psoriatic plaques. And you'll see them, you know, a lot of times on people's elbows, you see it along the hairline, along the sacrum on the back, and it can be pretty much anywhere, but those are real common areas you'll see it. Now, when you look at psoriasis, about 30% of the people who have psoriasis, because it is a true biochemical autoimmune problem, will develop psoriatic arthritis. And what that means is now I not only have psoriasis, but I have an inflammatory joint disease along with my psoriasis. So it's almost a third of people with psoriasis develop psoriatic arthritis. And again, psoriatic arthritis is similar to rheumatoid arthritis in its presentation. It's an inflammatory arthritis, and it can create not only a lot of pain, but a lot of joint dysfunction as well. So psoriatic arthritis and psoriasis are sort of a— they're 2 different diseases, but they are related to one another. Generally, you have to have one to have the other. Then we have a condition which is extremely common and getting more common called lupus. You've probably heard of, and normally they call it SLE or systemic lupus erythematosus. And they originally, when they first started to describe lupus in the 1800s, which is about as far back as we have records of lupus being described, they thought it was a skin disease because it would come out with, and this is not in 100% of people, but it would come out with a classic sort of rash that would often be on the face and came to be known as a malar rash or a butterfly kind of shaped rash. And a lot of times when doctors are trying to sort out rashes on the face, when they look like that, there are other types of dermatologic problems that can look like lupus. So a lot of times then, as we'll talk about later, you have to go and you have to do testing. Sometimes things like biopsy but a lot of them are blood tests that are done to see if the immune system is hyperinflamed and in autoimmune direction. And that's more indicative of a classic lupus presentation. So there are a lot of people who have lupus who actually don't show up with the facial rash, but they'll have the internal manifestations. So a lot like, you know, psoriatic arthritis is an internal manifestation of psoriasis, an external disease. Lupus, the rash is just sort of a piece, a little piece of the picture of a very big disease that's affecting the inside of the person. Now, one of the concerns that you have with these major, you know, what we think of as the name-brand autoimmune diseases, is that the longer that they go on without treatment, you can wind up with a great deal of inflammation inside and damage the internal organs. So treatment becomes very, very important when it comes to what you're going to do about things. Now, the next ones, I'm just going to go through these really kind of quickly because you kind of get the idea. So we talked about lupus, the inflammatory bowel diseases, which include Crohn's and colitis. We've talked a lot about them before. Addison's disease, which is an attack on your adrenal cortex. And so you have a low cortisol output, which can be potentially deadly. Graves' disease, which is immunologic attack on your thyroid where you go into a high thyroid state, hyperthyroidism. And then you have Hashimoto's thyroiditis, which usually winds up as a low thyroid state. So you have Graves' and Hashimoto's as 2 thyroid attacks by the immune system. You can have Sjögren's syndrome, which attacks a lot of the glandular Tissue in the head ENT area. Myasthenia gravis, so MG myasthenia gravis is where you actually are having autoimmune attack against the against the neurological system that that allows your muscles to contract and respond to stressors. And so one of the things people notice with myasthenia gravis is they will get fatigued, greater and greater fatigue with exertion, and it's really a muscular problem. But the problem starts where the nerve endings are attacked that go to the skeletal muscles. Then there are something that just, you know, in the, say, the 3 decades I've been working with patients, I've seen get, you know, much more common autoimmune vasculitis family. And this is literally where the inside lining of your blood vessels become attacked. And there's different subcategories of this, but that can obviously be very dangerous because you have small blood vessels. Any blood vessel being inflamed is bad, but the small ones like inside your eyes and inside your brain and your kidneys and other important places, you don't want little tiny blood vessels being inflamed all the time because they tend to clot, have other problems like that. Uh, pernicious anemia. This is where You wind up with an inability to absorb vitamin B12, and so you get a large cell anemia, and that can lead to a number of problems downstream because you need B12 and then folic acid, its cousin, to work together to help you with your DNA production, other very important things. So you wind up with a lot of neurological disease and a lot of other problems that go along with it. And then the last one— so we've talked about 15 or 16 here— is celiac disease. We've done whole programs on that. I've got some YouTube Shorts on it as well. You can go back and look at that. But bottom line is celiac is an autoimmune attack, uh, on the GI tract. And so you wind up with an intolerance to anything in the gluten family. So we think of wheat, but there's a number of other grains that are gluten-producing grains. So I want to take and just take a brief pause right there to say, okay, this— that's our first section, which is, you know, what is autoimmunity? So it's an immune system attack on yourself, hence autoimmunity. And so your immune system has for some reason gotten misguided and decided some part of you needs to be attacked. And so it thinks that that part— so in rheumatoid arthritis, it thinks that the synovial membrane inside your joints is not you. And so it starts to attack it. You can see this is a very bad thing. Or my— in the autoimmune vasculitis, the inside of my blood vessels is not me. And so the immune system keeps attacking it. Okay. So this leads then to why in the world— okay, if we have a disease state being autoimmunity, the category, and since 1950, it's just increased, you know, in amazing amounts. Um, pretty much around the world. Why would that be happening, and what would be the causes and the triggers? Okay, so part 2, what we want to do now is look at causes and triggers of autoimmunity, because then that leads us to potential targets for treatment and also targets for treating the underlying causes that go on. So the first thing is Are there any genetic or constitutional types of presets? And indeed there are. So women have about a 2-to-1 autoimmune rate over men. And not certainly time for it today, but I just did a presentation to doctors on the hormonal connection between autoimmunity and the various hormones in the body. So anytime you start to have something where there's twice as many disease state in women than men, You start thinking maybe the reproductive hormones get involved, etc. And indeed, that's a piece of the puzzle. Also, there are some things like lupus that affect people of color more than Caucasian people. So, for example, more African Americans and Hispanic people than Caucasians will develop lupus, and there's different you know diseases that have these predilections. Multiple sclerosis and lupus are known to. run in families. And people always say, well, yeah, I mean, I have an aunt with, you know, lupus, but everyone else doesn't have lupus. This sort of gives rise to the idea that we need to think about that the underlying triggers for autoimmunity, and sort of the fuel to the fire have to be in place. So it's not just genetics. It's epigenetic triggering, which is what, what happens to your genetics. So we'll get into that a little bit. And I've— in the links, I'll put in some links to some of these, uh, you know, statistical things. In looking at, you know, the— okay, so we, we don't have one cause for autoimmunity. What are things that have been proposed in the research? So things like genetics, diet, infections, exposure to toxins— those are your big ones. And if you think about it, what's one thing that's probably changed in the world since, you know, the end of World War to. One of the things is the, uh, our genetics really haven't changed, okay? But our exposure to toxic elements, which are big, um, you could say, um, uh, epigenetic stressors or epigenetic triggers, our exposure to toxins is, is exponentially higher than it was in 1950. And it exponentially even more elevated than it was 20, 30 years prior to that. So the toxic theory is a very common one. Also chronic infections. And there, there's a feed-forward problem where you have chronic infections, and then you also, by having autoimmunity, your immune system not working quite correctly. So then you have one feeding the other. Now, in just to mention some areas that we want to look at, and then we want to move into the treatment side in the second half. I've got 2 sections there. But if we think about it, then what would aggravate— what would be the epigenetic aggravations that would cause my immune system to want to continue to attack me and give me autoimmunity? So things that we would think of certainly would be the whole family of toxins. Yeah. Chronic infections are always in there. Hormonal imbalance, and I've got some links there if you want to look into that. A lot of diet and lifestyle triggers. And again, our food is much more toxic than it used to be. And that's a— that is a secondary event to modern food production and the use of pesticides and herbicides and a number of other things that go on with your food. So diet and lifestyle triggers digestive system imbalance. So digestive system dysbiosis, meaning the wrong kind of, uh, good bacteria and balance of bacteria and the microbiome being thrown off. That gets thrown off by a million things in modern life that it didn't used to so much. Allergies and sensitivity, and then neuro-emotional things. So there is a big— and I put just 2 references of many, uh, there are big correlations between, you know, neurological and neuro-emotional issues and autoimmunity. They're very strong correlations. There's also a fundamental problem where if you have autoimmunity for a long time that's untreated, you will develop neuro-emotional problems because of brain inflammation, because the inflammation is not reserved just for one part of the body after a while. All right, so that's part 2. So part 1 was what is it and what are our major autoimmune diseases. Part 2 is why would my body do this? You know, what— who is more likely to get it? Why would my body decide to target the immune system against me? Okay, that doesn't sound like a very sporting thing to do. So then what we want to do is we want to spend the next half of the program looking at at 2 sections. One are, what are the standard type therapies if you go to the dermatologist or the rheumatologist to deal with your autoimmunity? What are they and what are the pluses and minuses of those therapies? And then what are the types of therapies that an integrative practitioner might do to try and either come alongside or decrease the need for the standard therapies by targeting some of the cause areas? So, and because I don't have a helper in the studio right now, I just need to go press one button. So I'm not disappearing, I'm just going around the corner for 10 seconds. Promised I'd come back. All right, so in the second half, what we're going to do is talk about therapy. So in the world of your standard type therapies, if you will, the— some of the oldest therapies are fairly old-time drugs. They haven't been around forever, but they've been around. And interestingly, some of these drugs really became in common use in the 1940s and '50s. So if you look at pharmacology from World War II prior, There weren't that many drugs, especially some of the, you know, more modern ones that we have. Some of these existed then. And then you look at the development of things like a lot of antibiotics and steroids and other stuff like that. That came kind of during and after World War II. So the first therapy often that's done with regard to autoimmunity are steroids, and that's because they sort of universally decrease your immune system's ability to respond. Now, this is going to be a theme through all of the standard therapies, and that is the upside of blocking immune function is that my autoimmune disease now doesn't have the drive to create a lot of symptoms. The downside of blocking immune function is I need my immune system to work. And so if I have a blockade of immune function, I'm going to get a benefit on the side of my symptoms, but I'm going to open myself up to potentially not dealing with infections very well. And that indeed is one of the biggest problems in, in almost all of the treatments for autoimmunity. Not all of them, but in many of them. So steroids, certainly because they kind of universally dampen the, um, the immune activation and immune activity, are, uh, good In that they can get the disease symptoms under control, but they're not good in that your immune system isn't able to respond to what it needs to respond to. So some older drugs that you may hear about, or you might even be taking, that are used— colchicine. So colchicine is a common drug. It's used for gout. Where you get uric acid swelling in joints and things like that, but it's also used in other types of inflammatory disorders. Colchicine is sometimes used in rosacea, skin inflammatory problem, Mediterranean fever, and some other types of inflammatory problems beyond gout. One we heard about a lot in the in the early days of COVID hydroxychloroquine. You may be on a drug called Plaquenil, but that's hydroxychloroquine. hydroxychloroquine, and it is an immunomodulating drug. And it's used a lot in people who have, say, you know, lupus and rheumatoid arthritis. It's also used— hydroxychloroquine is also used in malaria. It's an anti-infective drug as well. And then it's also used in people that get chronic inflammatory skin problems like chronic hives, recurrent hives, etc. Another real common one, you may have seen someone or you might be on is sulfasalazine. Sulfasalazine kind of works in, in a similar place, uh, to where steroids work, but it works in a non-steroid manner. And it's also not as potent as giving someone, say, prednisone, um, as a steroid. So sulfasalazine slows down the production of some of the precursor molecules that create the inflammatory cytokines. So It's sort of a broad immune suppressant. It's used in a number of different inflammatory rheumatologic diseases. Then a little bit newer than sulfasalazine is a drug called dapsone. And this was originally developed as an anti-infective drug. It was used— it still is used if someone gets leprosy, for example, and some other really nasty infections. But it's also used as a potential trial in people who may want to decrease their steroids, get off their steroids in autoimmunity. All of these things like colchicine, hydroxychloroquine, sulfasalazine, dapsone are kind of broad-acting agents, and they're often used alongside steroids. And then the steroids, you try and drop the dose as much as you can. Many people have heard of a very old drug called methotrexate. Methotrexate blocks the way that your cells use folic acid. So it decreases the turnover of cells. Now, that's good if you're targeting the immune system, which is what the target is in autoimmunity with methotrexate. It's bad because then you don't have those immune cells turning over to help protect you. Again, there's always a cost when you start to suppress one side of the system to benefit another. Now methotrexate kind of comes in 2 varieties. The methotrexate was originally kind of coming into the pharmacology world at about the same time as the corticosteroids, and methotrexate was being looked at as probably the leading drug to use in rheumatologic conditions, autoimmunity. And then steroids were being developed and they were easier to use. They're certainly easier to use than methotrexate, and they sort of more universally worked. Well, upside, the steroids work really quick and well, and they're kind of, you know, universally inhibitory. Downside, they're universally inhibitory and you get a lot more problems. Methotrexate, you've got specific issues such as methotrexate is used if you have, say, you know, a tubal pregnancy. They call it ectopic pregnancy because it stops rapidly dividing cells like, you know, the embryo that's stuck where it shouldn't be. Again, okay if we're trying to slow the immune system down, but, you know, you don't want pregnant women, for example, to have methotrexate. Kind of the same theme goes along. Now, something I will say with methotrexate is I said it kind of comes in 2 varieties. Modern methotrexate dosing is really what we call low-dose methotrexate. So it's not the high dose, and it's a little bit more nuanced. Than methotrexate used to be. Something that is very interesting to me and also will feed into our last discussion of underlying diseases is the drugs like CellCept. So mycophenolate, this is actually an immune suppressant that is a mycotoxin. It's a toxin from molds. And what we're going to see is that mold and mold exposure and mycotoxins are actually one of the things that can feed into the cycle of autoimmunity. There are drugs made out of certain mold mycotoxins because they're such effective immune suppressants. But then the downside is it's immune suppressive whether you get it from the mold in your environment Or from the drug, and so it might help some symptoms, but it's going to open the door up to more infections coming in. Then there's a drug called Imuran that's been around for quite a while, and it again is something that actually provides like a chunk of DNA to get into the cells and slow them down—the T and B cells—from turning over, which again is great if you're going for immune suppression, but it's also going to. not make you as able to fight off infections. Then you've got— so general immune suppressants. Then you've got your immunity drugs, and these are in the category of your biologic drugs. So the biologic drugs are going to be things that you see a lot of TV ads for. These are newer drugs. They tend to be very expensive. Many of them need to be injected because they're complex molecules and they would wouldn't make it through the digestive tract, although that's not universally true. And if you look at the list— and I'm going to try and put the list into the notes in YouTube if the, uh, the number of character count will allow it. If not, I might find another way to do that. But there's literally a very long list. So we just went through, I don't know, about 10 general immune suppressant drugs. The innate immunity drugs and the biologic drugs—you know, there's probably thirty here in the list. I'm not going to go through all of them. But here's the up and downside: if you're looking at a targeted therapy, so a biologic medication, the selling point is well, it's not like steroids where it suppresses your whole immune system; it just suppresses a piece of your immune system. System. And the idea with targeted drugs, whether it's cancer or autoimmunity, is if I can find the pathway most likely to cause the autoimmune problem, and then I can target that pathway with a drug that just works in the autoimmune-triggering area, then I can maybe treat your autoimmune symptoms with the least amount of immune suppression. And it turns out that that's true to a degree. You get some really good symptomatic improvements with the biologic-targeted therapies in autoimmunity, but the downstream effects are still immune suppression in many cases. So for example, when you look at most biologics, their warning labels usually revolve around things such as you know, watch out for increased infections and other immunologic problems that go on. So there's some— I'll just mention a few that you've probably heard of. The TNF, the tumor necrosis factor blocking drugs like Humira and Remicade, Enbrel, those sort of things. Those again, tumor necrosis factor, it sounds aggressive. It's a cytokine that's created in your body. It was first found eating tumors, so they call it tumor necrosis factor. Now we know there's a number of different types of tumor necrosis factor. But so we have TNF, and if you block it, it decreases a lot of inflammatory problems. So like Humira and Enbrel and these other things are used for, you know, a lot of big-time disease states. Again, great for shutting down the disease and the disease symptoms, not so great because it also suppresses the part of the immune system that should be watching out for for cancer and other types of things like chronic infections, etc. So these things always have a cost attached to them. Now, we have to be careful about, you know, making widespread judgments about, you know, drug classes and stuff, because I can tell you that there are people who I've seen whose lives were saved by biologic and targeted therapies. And so they, they can be used judiciously Obviously, the problem is, is that once they're working, if you don't know that you have these infections inside of you, and when you have a powerful immune suppressant like a steroid or tumor necrosis factor drug, you can be totally asymptomatic and have 5 or 10 infections working inside of you with no symptoms. We see this all the time with people, or you can have cancer starting or other things. So you have to be very careful with these. Usually, like with the TNF drugs, because I just talked about them a little more because they're so common, you know, they, they want you to be tested for tuberculosis. Well, that's because early on, you know, they would put people on TNF-blocking drugs and their autoimmune disease would seem to go away, and then they would— didn't realize they had tuberculosis, and they would develop tuberculosis or hepatitis or something like that. Right. Well, that's not very good. So you usually are screened for stuff before. The problem that we see with patients is they, at certain points, may develop cancer or they may develop other complex chronic infections because this part of their immune system has been suppressed. And really, if you look at— and again, if I can get it in, I will. If not, I'll have to truncate it and maybe put it somewhere else. You look at the drugs and you look at all of the targets that they have Just about every part and piece of the immune system where you have signaling molecules in the immune system that might be turning on the autoimmunity can be inhibited. Problem is, if they're messing with a piece of your immune system, they're still going to cause downstream immunodysregulation, and that can make you more open to infections, make you more open to cancer and certain other things. And there's, I think it's 2 and a half pages single-spaced of, of these drugs. So it's not a small amount. Like I say, because, you know, they're quite expensive, the biologic medication market for cancer and autoimmunity is, is billions and billions and billions of dollars. So the drug companies are putting a lot of money into developing them and also to selling them. So you'll see these things, and you always see on like TV ads, you'll see the side effects, you know, this infection, that infection. That's because they have this effect just like the steroids do, but in a more elegant way of creating it. That's Section 3, the standard types of treatments. You've got this balancing act, the good side of controlling the symptoms balanced with the bad side of suppressing the immune system through one means or another. In the last section here, and this will probably be one that we'll do the kind of a top-down look here, and then I'll maybe get into in its own podcast, uh, in the coming— in the short future, would be, okay, so if we have, you know, obviously a disease state like autoimmunity, uh, that has gone from known disease but very infrequent prior to World War II time period— and again, there's nothing probably about World War II, it's just sort of a time period— uh, to after World War II to now, This, this big increase in frequency. And like we said, you know, if you look at total number of people with cancer in the United States, 13 million. Total number of people with autoimmunity, 23 to 24 million. Um, that's a pretty big deal, you know. Uh, so it certainly didn't used to be like that. Now, what would be other or integrative approaches that we could think about? So we think about— we the problem, which is your immune system has decided some part of you or some tissue type is, uh, not appropriate and it's not part of you anymore. The immune system has made this decision. Now it has become non-self, so not you. And so the immune system is constantly attacking it, whether it's the lining of your joint or part of your thyroid or whatever it's doing. So what are ways to step back and say, okay, we have that problem, we have these causes that we don't know exactly which it is, which means it's probably all of them, but they're all epigenetic triggers that cause your genetics to more likely become autoimmune. And so those causes then are things like inflammatory triggers, chronic infections, toxicity of all types, etc., etc. So if we're not, you know, we're looking at augmenting our targeted therapy, you know, say one of the cytokine-manipulating drugs or whatever, but we want to get to these underlying problems, how do we do that? Well, we target the epigenetics of the situation. And so one of the best ways to do this is to try and seek out and remove as many underlying problems as possible. Yeah. Now, this is difficult. It's a lot easier to give somebody some steroids and, you know, maybe some Imuran or some Plaquenil or whatever. And that certainly is appropriate depending on the disease state. But it takes a lot longer time, a lot more investigation, and a lot more underlying detective work to sort out how do we get at the cause areas. to deal with these problems. So remember that the epigenetic triggers that turn the genetics on are going to tend to be things that are pro-inflammation. So those toxins are mentioned by almost everybody who writes about autoimmunity. And we live in a world that is so much more toxic than it was 50 years ago, 70 years ago, 100 years ago, that it's not that far of a stretch to say, well, a lot of diseases are probably fueled by these toxins. And the thing is, we can't get away from toxins in the world. There's no non-toxic place left in the world. And so it's just something we have to deal with. Now, we can do things to decrease our exposure. We can have air filtration. We can try and eat food that has the least amount of added chemicals to it. We can make sure we're not living in a place with mold and mycotoxins and all of that. But the other thing that we usually do with patients when they have kind of a bad thing going on with autoimmunity is we actually do some screening tests for these different toxin categories. Usually the screening tests can be done with urine tests, which is nice, especially if it's a child. And there are these childhood autoimmune cases, but adults too, they kind of like not getting your blood drawn. So the mold toxins, chemical toxins, and metal toxins, can be screened for with screening urine tests that can be done. Now, why would we do this? You want to— it's not that it's, it's not that it's not there or there so much as is it a small, medium, or large part of the problem. So if we see people and they have, you know, a ton of mold toxins, the mycotoxins coming out of their body, um, we know that number one, we have to find out where they're getting exposed and get them away from that and get that fixed. But then also we have to help their body get rid of those mycotoxins or mold toxins. Um, chemical toxins, kind of the same way, might be that you're being chronically exposed in your water or your food, and it might be that your body has held on to them from maybe a work exposure and it's releasing them. So again, a little detective work. Same with metal toxins. Infections are huge in this, and these are often what we call stealthy infections that kind of fly under the radar. And remember I said, if you're on a lot of the targeted drugs or the steroids, you often don't feel like you're infected, but you are. So we test people for a broad group of chronic infections because toxins and chronic infections feed into, uh, being pro-inflammatory. And that's like pouring gas on your immune fire that you already have going on. So you can't just treat one thing and then leave, you know, for instance, deal with, say, the mold or chemical toxins and then leave all these infections sitting there to do nothing. Hormone imbalance, we mentioned, that's huge. A lot of diet and lifestyle triggers, so pro-inflammatory diet and lifestyle. Digestive system things, we mentioned imbalances. Allergies and sensitivities certainly feed in. And in people where we have a lot of, say, digestive or skin problems, Testing for allergies becomes very important. Then remember we mentioned the neuro-emotional situation, which is not universal in autoimmunity, but it's very common, and dealing with that can be another epigenetic trigger that we can lower. So the common targets in treatment— this will segue over to the next podcast and do a whole deep dive. dive are going to be dietary treatments, constitutional treatments, which might include acupuncture, might include hydrotherapy, might include things like homeopathy, etc. Immune— natural immune manipulators. So vitamin D, vitamin K, antioxidants. There's a lot of herbal products that are immunomodulatory, you know, like the artemisia family and curcumins and other things. And then there's some, uh, sort of off-label drug things like low-dose naltrexone, other things of that nature that you might use. So since we're going to kind of dive into these treatments, the integrative treatments for autoimmunity in its own setting, I just want to illustrate how autoimmunity sometimes can be reversed and sometimes not. It's very common in people who are chronically ill when they come in and we test them Because whenever you have, say, chronic fatigue, chronic pain, etc., you should always be screened for autoimmunity. And so, for instance, lupus can look a lot like chronic fatigue or fibromyalgia and other things of that nature. And it doesn't mean that one is exclusive to the other, just means they can coexist. But we've had a lot of people where their autoimmune markers are high and they have all the symptoms, but they also have chronic infections and toxicity and gut problems and all this stuff. And when we fix those things suddenly their autoimmune markers go away and they're not quote-unquote autoimmune anymore. Now, are they prone to autoimmunity probably for their whole life? Yes, 100%. But did, did they, by working on the underlying problems, take the autoimmunity away as a symptomatic disease? Also true. There's a lot of people that's too far advanced, they can't do that, but they can reduce the intensity of the disease, and that becomes very, very important. Well, we are just about to the end of our time here together, and as I said, as I kind of assumed at the beginning, we're going to have to break out this integrative treatment approach, and we can really get into the kind of the specifics and maybe even compare and contrast them to some of the targeted therapies. therapies in the drug world. And, you know, just to keep in mind, if you need a particular drug to control symptoms so that you don't lose function or so you don't die, etc., that you need that, but you also need to work on all these epigenetic triggers too. So, we tend to try and do it together as a holistic model. And then the goal is to need the least amount of the drug therapies possible, because the longer you need the least amount, the better. Then you have more for later if you need them. But we're at the end of the program for today. So, Dr. Paul Anderson, please, if you're on YouTube or the Podburners, like, share, subscribe, make some comments. Let me know what you think, and I will see you all on the radio next week. You can also check us out on dranow.com. See you next week.
