The Paleo NP Podcast Episode #11: All About Autoimmunity & Listener Questions
News & updates
Something new I'm into
What is an autoimmune disease?
What causes an autoimmune disease?
What is the treatment for autoimmune diseases?
Thyroid hormone replacement
Iodine and Hashimoto's
No diagnosis, but lots of lab work
Theme music courtesy of soundotcom.com
You’re listening to The Paleo NP Podcast, episode #11
News & updates
Hello and welcome back to another episode of the Paleo NP Podcast! This week I’m going to be talking all about autoimmune disease and answering some questions that I got, but before I get into that I’ve got some news and of course...something new I’m into.
First up is the ecourse I’m working on. It’s not quite done yet....I got sick and had a terrible cough, so really I did everyone a favor by not trying to record videos for that while I had a terrible cough and a stuffy nose. It would have either taken me four times as long to edit out all the coughing or there would have been tons of coughing in the recordings, so I decided to just wait until that wasn’t an issue before I did that step. So keep your eyes out for the ecourse, it’s still coming.
Also, a few weeks ago I did a survey on IG stories about blog posts, basically whether people wanted to see long and in depth posts or some shorter, more daily life type stuff and the responses were overwhelmingly tipped in the favor of daily life type stuff. So over the past couple of weeks I’ve been doing some shorter, but more frequent blog posts. Last week I did a few “what I ate in a day” type posts and this week there are a couple other random things (like Mondays post about mourning the loss of fictional characters).
So, I’m still doing some experimenting as far as what people actually want to read, but I’m also going to continue to do longer more informative posts like I have been doing, because I like to have posts for people to reference if needed and still want that really informative piece to exist as well. So go check out the blog, marthaflorence.com/blog and report back and let me know what you are loving and what you want more of!
Alright, onto something new I’m into this week is the Olympics. I mean they are almost over, but I’ve been watching a lot of them and, I think this happens every time I watch the Olympics but I get all excited and think that I’m just as good an athlete as any of the people competing or that I should try a new sport because they just make it look so easy, right? So I watched a whole bunch of the speedskating events and now I’m ready to go be a speedskater. Which, I’m sure is not an easy thing to do, but in my head I’m in pretty good shape (I mean, I just ran two 50K races over the course of the past few months) and I’m a pretty decent ice skater and I can cross country ski pretty well, so all of those things combined should make speedskating no big deal...right? I’ll definitely let you guys know if I ever try it. I’m sure it would be an entertaining experience to watch.
What is an autoimmune disease?
Alright so let’s dive into this week’s topic which is autoimmune disease. So last week I briefly touched on what autoimmunity actually is, but I wanted to dive into that a little bit more because it is so much a part of what I do with clients and it’s becoming a bigger issue for so many people, especially women. It’s one of the top ten leading causes of death in females (both women and children) up to age 64. The National Institutes of Health estimates that 23.5 million Americans suffer from one or more autoimmune conditions (compare that to the 9 million Americans affected by cancer and the 22 million affected by heart disease). And the American Autoimmune Related Diseases Association actually estimates that over 50 million Americans are affected by autoimmune disease.
The difference between the NIH and AARDA statistics is because the NIH only includes the 24 diseases for which there are good epidemiological studies for. While the AARDA includes almost 100 different diseases that have been determined to have an autoimmune component.
Autoimmune diseases include things like rheumatoid arthritis, type 1 diabetes, Hashimoto’s thyroiditis, lupus, multiple sclerosis, IBD (Crohn’s and colitis), psoriasis, endometriosis, and many more. I’m sure I missed a few big ones but that’s what comes to mind at the moment…
All of those diseases, while they may seem unrelated, are forms of autoimmune diseases. These autoimmune diseases occur when your immune system, which is designed to protect you from foreign invaders, begins to attack your own tissues. This happens from the interaction between your genes if you are predisposed to developing an autoimmune disease and your environment. When you have an autoimmune disease, the body accidentally creates antibodies against itself - these are called autoantibodies. And genetics determines the likelihood of your immune system developing these autoantibodies, but environmental triggers are what actually makes it happen. Both genetics and environment determine how aggressive the immune system will be in its attack, which is why controlling environmental triggers is so important. If your body has already started making autoantibodies, removing the environmental factors that contribute to their creation will prevent the immune system from going completely haywire.
Symptoms can range from life-threatening requiring close monitoring and in some cases around the clock care, to mild annoyances that hardly disrupts a person’s life. Most people fall somewhere in the middle of the spectrum, living with these chronic symptoms that impact our lives but our healthcare providers and others who we are close to are unable to provide us what we need.
What causes an autoimmune disease?
There are three major factors that contribute to the development of autoimmune diseases - genetics, environmental triggers, and diet and lifestyle.
Genetics: The genes you inherit play a part in determining whether or not you are at risk for developing an autoimmune disease. Unlike a genetic disease where just one or two gene mutations is responsible for developing the disease, there are many genes that affect your risk for autoimmunity and you can inherit a cluster of genes that put you at risk for autoimmune diseases. This is why autoimmune diseases run in families, but also why many members of the same family suffer from different autoimmune diseases. Also, once you develop one autoimmune diseases are at an increased risk for developing additional diseases.
Environmental triggers: Blaming all autoimmune diseases on genetics seems like an easy thing to do, but genetics is only part of the story. The saying goes that genes load the gun, but environment pulls the trigger. Pathogens, chemicals, and other things that your immune system is exposed to in your everyday life can play a role in disease development. Certain viral and bacterial infections have actually been linked to the development of autoimmunity. Exposure to toxins and chemicals can as well.
Diet and lifestyle: And finally, diet contributes to the development of autoimmune disease by contributing to intestinal permeability (also called leaky gut), nutritional deficiencies, and creating and overactive immune system. Problems with sleep, lack of movement, and exposure to prescription and OTC drugs can also increase your risk of developing an autoimmune disease. Stress plays a big role in the disease process - those who have both chronic and acute stress are at a higher risk.
So, just because you develop autoantibodies as we talked about before, does not mean that you have an autoimmune disease. An autoimmune disease occurs when:
The body’s system for eliminating autoantibodies fails
The immune system is stimulated to attack your own cells AND
Enough damage occurs to cells or tissues that a symptom of a disease occurs
So while you can’t do a lot about your genetics, you can do something about managing your diet and lifestyle choices as well as making an effort to limit your contact with exposure to toxins and chemicals.
There are all sorts of things that cause your immune system to become overworked and fail to differentiate between an actual intruder and your own cells, but one common example of this is gluten. Not only does gluten contribute to leaky gut and inflammation, but from the perspective of your immune system, gluten looks very similar to your thyroid tissue. So you’ve got partially digested gluten proteins that leak out of your gut and into your bloodstream because you’ve got leaky gut and your immune system is busy keeping all the normal things (like viruses and bacteria) under control, as well as keeping up with all the inflammation in your body from stress and a poor diet, and then you’ve got these gluten proteins floating around that look kind of like thyroid tissue and suddenly (at some undetermined tipping point), it can’t see the difference or gets confused between the gluten and your thyroid tissue and it starts attacking your thyroid. It’s like when you are trying to have a conversation with too many people at once via text message and suddenly you’ve sent the wrong text to the wrong person, or when you are quickly scanning through a ton of numbers in a spreadsheet and you mistake a 1 for a 7.
What is the treatment for autoimmune disease?
So now that we understand what an autoimmune disease is, let’s talk about treatment. The treatment options from a conventional medical standpoint are not all that great. Because so little is understood about the actual cause of autoimmune disease, the treatment part gets tricky. Now, ask any conventional doctor or healthcare provider what causes an autoimmune disease and they will probably say that we don’t know. Now at the beginning of this episode I told you about three things that contribute to the development of an autoimmune disease, and I think that conventional medicine would probably at the very least agree with the genetics portion, but I doubt that most conventional medical practitioners would agree with the rest of it. And that’s not to say that there’s anything wrong with them or the way that they practice, but most of them just weren’t taught to think about things in this different way like functional practitioners are.
So the treatment option for autoimmune disease generally include things like immune suppressing drugs, anti-inflammatories, and steroids (which are both immunosuppressive and anti-inflammatory). So these drugs are great if all you want to do is stop the symptoms, but they do absolutely nothing to address the actual cause of the disease (again, a common problem with conventional medicine). The other issue with most of these medications is that they cause a huge number of undesirable side effects that either end up getting you more medications to treat the side effects or that aren’t actually severe enough to warrant any treatment and just something that you have to put up with. It really can feel like a lose-lose situation for so many people.
So if you come at this from a more holistic or functional perspective, and address the part of the three things that contribute to autoimmune diseases that you can control - so environment, and then diet and lifestyle - there is so much more that you can do.
And I’m not going to get super detailed about this because I want to move on to some questions, but the basics are that you absolutely need to address your diet. If you do nothing else, going gluten-free, especially if you have a thyroid condition, can do amazing things for you. Beyond that you’d want to address any food sensitivities cause eating foods that you are sensitive to contributes to inflammation in your body which contributes to the cycle of immune system dysfunction and overwhelm that is a problem in autoimmune disease as well as contributing to leaky gut - which I forgot to mention that there is some research that suggests that leaky gut is actually a requirement for developing an autoimmune disease. I think in every autoimmune disease that they’ve looked for leaky gut in, it’s been present.
Now, everyone always wants to go out and get tested for food sensitivities, but that testing is actually not super accurate and doesn’t always show everything that you may be sensitive to. I want to do a future episode on that because it’s really important. But, really the absolute gold standard for food sensitivity testing is an elimination diet. And I know everyone wants to do testing because they don’t want to do the work of an elimination diet, and I totally get it, but guys, you’ve got to be real with yourself - you either need to do the work and feel better, or you need to suck it up and live with your symptoms. I don’t mean to sound like a jerk about this, but that’s the reality of this situation. You’ve just got to do the work.
I can’t tell you how many food sensitivity tests I’ve gotten back and gone over with people and they say “oh but that doesn’t show….whatever….and I know I react to that.” So if you react to it, don’t eat it even if’ it doesn’t show up on your test. End of story. Anyway, elimination diet. It’s definitely worth the work if you have or even if you think you have an autoimmune disease. At the very least I’d recommend starting with something like a Whole30 or the Reset diet that I have in my book The 30 Day Energy Reset and following the reintroduction protocol in either of those programs. But sometimes you need to dive even deeper into something like an Autoimmune Protocol too. This is all stuff I’m going to get super in-depth with in my ecourse, so I’m not going to get nitty gritty with details now.
You also absolutely need to identify and manage your stress. I’ll link to a blog post that I have about how stress is probably making your autoimmune disease worse and what to do about that.
And then you need to address your environment and other lifestyle things that are contributing to exposure to things like pesticides, plastics, endocrine disruptors and so on that are present in your personal care products, cleaning products, food, food storage containers, and so on. Because, and I know I’ve used this analogy before, it’s like a jar of water in a paper bag and all of these things that are hits against your immune system are like drops of water into the jar, and you can’t see the jar, so you have no idea which drop is going to overflow it and cause you to develop symptoms of an autoimmune disease, so taking the time to fix the things you have control over like diet and lifestyle is so worth it.
Thyroid hormone replacement
Ok so I’ve got a few questions that I want to address, the first one (and I’m so sorry that I didn’t write down anyone’s name when I compiled these, so I apologize about that and, lesson learned). The first one is about thyroid hormone replacement. “When should I be put on thyroid hormone replacement? In my opinion, all signs point to a thyroid condition and I feel terrible most of the time, but my doctor says my labs are normal. I have done plenty of research and followed AIP for awhile, but I have not improved as much as I had hoped I would.”
Ok, so this is a great question. So, AIP does a great job of knocking out inflammation and healing leaky gut, but it absolutely does not repair or reverse the damage that may have been done to your thyroid and it is not a replacement for thyroid hormone if you need it.
Also as a side note, over 80% of hypothyroid cases are actually Hashimoto’s (which is the autoimmune version of hypothyroid) so if you have been diagnosed with hypothyroidism at any point but have not actually had your antibodies tested to see if you have Hashimoto’s that’s a really good thing to ask for. In Hashimoto’s your immune system sort of slowly destroys your thyroid and for a lot of people it can take 10 or even 20 years before they start to have any symptoms or even start to notice that anything is off. Also our bodies are pretty good at compensating, so in the early stages of almost any disease you likely won’t notice much because your body is able to keep it together by compensating in other ways - our bodies always want to be in balance, called homeostasis, so they do a lot to keep the illusion that everything is fine.
Now I don’t have the whole story here because I’m curious exactly what labs this person has had done. Because most doctors really only test a TSH which is really not all that helpful when it comes to any thyroid issue. So while your TSH might be normal, I’d be curious to know what your other thyroid labs look like - a T3, T4 and reverse T3 at the very least. Also, is you TSH really in range? Because conventional doctors usually only go with what the range on the lab form is, but in a functional practice there are other ranges that we use because they are where most people actually FEEL better. So for a TSH that would be around 1-2 or even lower. An honestly, testing a TSH to diagnose thyroid disease is pretty useless because the TSH (that’s thyroid stimulating hormone) comes from the pituitary gland and is what stimulates the thyroid, so what you are testing is how well the pituitary gland is working and how much stimulation the thyroid is getting, but it really says nothing about the actual function of the thyroid.
Anyway, if you’ve tried an elimination diet for awhile (and I also don’t know what a while is here, but I would say if it’s been at least 3 months) and you aren’t feeling much better, then it’s time to do some more digging. Now, that might mean finding a doctor who is more willing to do some additional testing, and that’s actually what I would recommend this person do since they say that their labs are normal, but I’m not sure we have the whole picture here. So I know that was kind of a convoluted answer, but the thyroid stuff can get pretty complicated, and most of the time it’s not a matter of either/or, it’s a matter of doing several things together to get the best result, and with thyroid it almost always involves medication because that’s such an important hormone in your body. But getting the diagnosis is the really hard part for most people.
Iodine for Hashimoto’s
Alright so next question is “my functional medicine doctor recommended that I take iodine supplements to support my thyroid. I have heard mixed things about this, is it good or bad for someone with Hashimoto’s?” So, the short answer to this question is that I do not like iodine supplementation. There are a lot of practitioners who believe that iodine is beneficial for people with Hashimoto’s, but I think it’s kind of like pouring more gas onto a fire. It can cause flare ups, especially in higher doses. BUT the tricky part here is that it seems that iodine might only problematic for the thyroid in the presence of concurrent selenium deficiency, so if you are taking iodine, you might want to get your selenium levels checked. But I still don’t really like iodine supplementation. I would prefer that you get your iodine, because you DO need it, it’s critical for thyroid function, but I would prefer that you get it from food sources such as sea vegetables. And I’m also not saying that this doctor is wrong, but it might be worth having a conversation about selenium deficiency especially if you don’t feel like your condition has improved or if it has gotten worse.
No diagnosis but tons of blood work.
Alright, so the next question is from someone who says that she has not been diagnosed with any autoimmune condition but she has had tons of blood work done, she says that she definitely has a positive ANA, and tons of symptoms, but no actual diagnosis and she says “I’m worried about being on the wait and see what happens plan which doesn’t seem like the best approach, especially if I am not feeling well.” For those of you who don’t know, an ANA stands for anti-nuclear antibodies, and that is a test that by itself does not diagnose autoimmune disease. So if you were to test the general population there would be a certain number of people who were healthy but still had a positive ANA. So a positive ANA does not mean that you have an autoimmune disease. So that could be one reason why you don’t have an autoimmune diagnosis, because your symptoms don’t not correspond with the diseases that go with a positive ANA (because a positive ANA is also not required for all autoimmune disease diagnosis).
But this also doesn’t mean that you don’t have an autoimmune disease, but that’s also one of the reasons why it may be unclear. So diseases where a positive ANA is required are usually more connective tissue type diseases like lupus or rheumatoid arthritis, or anything that you would see a rheumatologist for. So if you are someone who has been looking for answers for a long time and you feel like you’ve been seeing the right practitioners and they’ve been testing you thoroughly and no one has come up with anything. It’s ok to work on your own things in the meantime. So this would be someone who doing an elimination diet might be really helpful for.
I think for anyone who is just kind of stuck in that place where, you know, you are starting to have some symptoms or even if you have been having them for awhile but they are just starting to be really bothersome, those are the people who would really benefit from doing some of the things that I mentioned earlier, that diet, lifestyle, and environment piece. Because either it’s going to help you or your symptoms are going to keep getting worse and you’ll eventually get a diagnosis. But that’s the great thing about this approach is that none of the things that I suggested are going to harm you, so you don’t really even have anything to lose by trying.
There are so many people who live in that weird gray area between full-blown autoimmune disease and being completely healthy and then they make a lot of these changes, feel better, and don’t even care about getting a diagnosis anymore because their symptoms are gone. Now that’s not to say that everyone is going to be this way or that everyone is even going to be satisfied with not having answers for why they were feeling this way, and that’s ok. But if you just need to feel better and you don’t really care to keep searching for the “answer” make some of these changes and see what happens.
Alright, I’m so glad I got to answer a few questions from you guys. Keep them coming! If you have a question you’d like me to answer - you can do that at marthaflorence.com/question or you can head over to Instagram and just leave a comment on whatever my most recent photo is with your question!
Thank you so much for listening this week. You can find show notes for this show at marthaflorence.com/episode11. And if you enjoy this show, I would love it if you would leave a rating or review on iTunes, you can even do it straight from the app on your phone! See you next week!