It is estimated that 25 to 50 million Americans suffer from autoimmune diseases - one million alone have multiple sclerosis (MS). But I have always said that no one just walks in the door and gets MS. So we must look at the root cause of this and any disease to best provide a treatment plan with real benefits.
Functional Medicine teaches that immune imbalance, while often resulting from a genetic disposition, will generally arise in the context of one or more of the following: the habitual consumption of a pro-inflammatory diet; food allergies and intolerances; microbial infections; hormonal imbalances; nutritional insufficiencies; and xenobiotic exposure.
Nearly 100 different diseases have been classified as autoimmune in nature with 40 more suspected. While these conditions tend to be viewed as separate entities, a broader perspective may reveal that shared mechanisms are the underlying cause of these maladies. It is abundantly clear that environmental factors have important parts to play in the underlying etiology. In rheumatoid arthritis, for instance, genetic factors have been shown to be responsible for less than 50% of the risk. This means that environmental factors, and gene-environment interactions, must play a significant role. Despite this understanding, less attention has been focused on determining these other important causal factors.
What do we know so far?
Gut dysfunction: We know with intestinal permeability and alteration of our microbiome that there is alteration of the oh-so-important blood brain barrier. Evidence has been emerging for a role of alterations in the gut microbiome in several autoimmune diseases including MS, presumably through interactions between the intestinal microbiome and the host immune system. Diet is the main factor affecting the health of the microbiome although other factors such as chemicals, toxins, mold, frequent antibiotic use, other pharmaceuticals and stress can cause gut dysbiosis as well.
In this study in Denmark, this children treated with antibiotics had a higher risk of developing a psychiatric disease showing just how critical is the gut-brain connection and its impact on our health. Another study, “Gut microbiome of treatment-naïve (never having received treatment) MS patients of different ethnicities early in disease course,” showed that all subjects, regardless of ethnic background, have an abundance of the bacteria group Clostridia compared to people without MS. The importance of the gut / microbiome cannot be overstated and healing the gut is massively important in the treatment of autoimmune disease.
Vitamin D deficiency: Vitamin D is critical to having a healthy immune system and while many of us have some level of deficiency due to our lifestyles and diets, a significant deficiency may actually predict MS.
Chronic infections: Microglia are the resident immune cells in our brain. We used to believe that the blood-brain barrier (BBB) was impenetrable but now we know that chemicals, toxins, viruses, bacteria, fungi and more all cross the BBB and activate microglia leading to neuro-inflammation. Since the BBB regulates the communication between the vasculature and the brain, the more “leaky” the barrier becomes, the easier it is for substances that cause inflammation to cross over from the bloodstream into brain tissue and damage cells. Some infections that have been associated with MS include chlamydia pneumonia, Epstein Barr Virus herpes virus, Lyme disease and infections associated with Lyme, fungi and staphylococcus aureus that produces enterotoxins and the human retrovirus. In yet another study, researchers found that “Increased serological response against human herpesvirus 6A is associated with risk for multiple sclerosis,” (Frontiers in Immunology, November 2019). The hypothesis is that the virus is able to mislead the immune system into attacking the body’s own tissues, damaging the brain and spinal cord. Results showed that MS patients had a 55% higher risk of carrying antibodies against HHV-6A than healthy people. Researchers also saw that the younger the age at which patients tested positive for the HHV-6A virus, the higher the risk of MS. More than likely it is “the perfect storm” with multiple infections, chemicals and toxins that can act together to raise a person’s susceptibility to the disease.
Genetics: The risk for a child with one parent who has MS is approximately 2%. The International MS Genetics Consortium (IMSGC) concluded that MS risk is governed by a cumulative effect of dozens of allelic variants throughout the genome, probably involving as many as 200 genes (The American Society of Human Genetics. But it is the ENVIRONMENT, or epigenetics, turning on these genes that opens the door to a life with MS.
We will continue to look at the findings of ongoing research and clinical evidence that can help us best treat our patients with the most appropriate protocols and resources.
Dr. Suzy Gazda
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