About Autoimmunity

On Wednesday, the the NIH's National Institute of Environmental Health Sciences (NIEHS) and the National Cancer Institute (NCI) issued a press release saying that long-term pesticide exposure may increase risk of diabetes. (Gee, you think maybe?) The press release did not elaborate into whether this exposure increases the likelihood of autoimmune type 1 or insulin resistance, which is better known as type 2 diabetes, but it seems very likely that some of these influences very likely contribute to the rising incidence of both types, as well as a host of other ailments. In fact, I have seen recent research suggesting that autism which has not historically been considered a disease might actually be attributed to autoimmunity.

The NIH looked at the incidence associated with some particular pesticides, and also noted that although some pesticides and/or insecticides in this study are no longer available on the market, the chemicals still persist in the environment and measurable levels may still be detectable in the general population and in our food products. For example, chlordane, which was used to treat homes for termites, has not been used since 1988, yet can remain in homes treated with it for many decades. More than half of those studied in the National Health and Nutrition Examination Survey in 1999-2002 had measurable evidence of chlordane exposure.

None of this is terribly surprising, but at least we finally have some solid evidence of it, rather than simply relying upon the Birkenstock-wearing, granola-eating "green" pseudo-hippies stating their conspiracy theories. While I do not generally subscribe to such theories, I do believe that massive changes to our living conditions over the past 100 years has had a profound impact that has yet to be fully quantified. The most basic assumption behind this belief is that the power of the almighty dollar often motivates behavior that is not always in the best interests of the public, therefore totally free markets need some intervention (called regulation) to ensure everyone has a level playing field. However, when regulations are not sufficient, it leads to abuse of the system.

The environmental element is an important factor behind autoimmune diseases according to at least one journalist and author, Donna Jackson Nakazawa, who has published several books. Her latest book was published this spring, and is entitled "The Autoimmune Epidemic: Bodies Gone Haywire in a World out of Balance and the Cutting-Edge Science that Promises Hope" in which she discusses the history of autoimmunity and how it was not even acknowledged by the medical profession until the 1970's, and she also discusses cause for the increase. Thursday's Baltimore Sun did an interview with her which was very interesting reading. I have included that article here (since the Sun does not save article content for an extended period of time):

Body wars
By David Kohn, Baltimore Sun reporter
June 5, 2008

Author Donna Jackson Nakazawa answers our questions about the spate of autoimmune diseases



For 10 years, Donna Jackson Nakazawa has suffered from a range of autoimmune diseases - ailments in which our cellular defense system mistakes friend for foe and attacks the body's tissues. Among the diseases caused by autoimmunity are: rheumatoid arthritis, multiple sclerosis, lupus, Type 1 diabetes, thyroiditis and many others.

A journalist and author who has published several books, Nakazawa became fascinated with autoimmunity and spent the past three years exploring the topic. The result is her latest book, published this spring: "The Autoimmune Epidemic: Bodies Gone Haywire in a World out of Balance and the Cutting-Edge Science that Promises Hope".

How did you decide to write the book?

Three years ago, I developed Guillain-Barre syndrome, an autoimmune disorder that paralyzed my arms and legs. For a long time, I couldn't move. It took me five months to learn to walk again. I decided that if I could ever get back the ability to type, I would write about what causes autoimmune diseases and what we can do about them. After I got better, as I talked to scientists in the field, I realized that the story was actually much bigger. These diseases have become a frightening epidemic. People at [the National Institutes of Health] were telling me this was scary, and no one was talking about it.

So, how big is the problem?

Twenty-four million Americans have an autoimmune disease. That's one in 12 Americans, and one in 9 women. Nine million Americans have cancer, and 22 million Americans have heart disease. So more than double the number of people who have cancer have an autoimmune disease. Scientists around the world have been looking at this, and over the past 10 years, 15 peer-reviewed journal articles have found that rates of autoimmune disease have been doubling and tripling around the world. You begin to see that not only do we have an epidemic, but it's growing.

Why does autoimmune disease remain relatively unknown as a medical phenomenon?

The idea that autoimmune diseases even existed was not widely accepted in medicine until the late 1970s. It wasn't until the late 1980s that the idea was taught in most med schools. So we are late out of the gate compared to our war on heart disease, our war on cancer.

The other thing that happened is that as autoimmune diseases were discovered, they were farmed out to different specialties. The neurologists took over on neurological autoimmune diseases, the endocrinologists took over on endocrine autoimmune diseases, the rheumatologists took over on others. So you have groups of specialists working without any kind of integration.

In your book, you argue that our environment plays a large role in this epidemic.

Between 1940 and 1980, we were engaged in the largest industrial growth spurt of all time. ... We introduced every kind of chemical you can imagine: 80,000 new chemicals have now been approved for use in the U.S.

I talked to scientists all over the world, and they suspect that these chemicals are confusing our immune systems. As you and I are talking, our immune system has been checking out the safety of foreign agents that our body is coming into contact with hundreds, thousands of times, over and over. Usually, the system works.

But what's happening now is that our immune systems are getting so many hits, nonstop - not only from these 80,000 chemicals but from our diets - that they're overtaxed. We're eating very differently than we did 100 years ago. A lot of foods that we're eating are full of chemicals, pesticides and additives as well. So our diet is also putting stress on our immune system.

Think of each new thing, foreign invader - whether it's a bacteria, virus or chemical - that comes into your body as having a bar code on it. The immune system has to read those bar codes and decide if this new invader is safe or not. What's happening with all the chemicals in our environment is that many times our immune system is presented with a bar code that is very similar to tissue in our own body. When our immune system is overwhelmed, mistakes get made. The body mistakes the tissue of the body for the foreign invader and attacks both.

Give me an example of an immune-altering chemical.

I'll give you [three]. Trichloroethylene, a solvent used in dry cleaning, paint thinners and strippers, glues and adhesives; PFOA, a breakdown chemical of Teflon found in nonstick cookware, car parts, flooring, computer chips, phone cables, carpet guard, upholstery, new clothing, grease-resistant french-fry boxes and disposable coffee cups; and bisphenol A, or BPA, a plastics building block used in baby bottles, dental sealants, the resin that lines food cans, eyeglass lenses and food packaging; and phthalates, plasticizers found in cosmetics. Recent studies show that low doses of all of these can alter the basic function of the immune system, and, in many cases, trigger an autoimmune response.

What should be done to fix the problem?

National Institutes of Health allocates almost $600 million for autoimmune disease research every year. That contrasts with $5 billion annually for cancer, which afflicts 9 million Americans. The other thing that we need to do is to make autoimmune disease a reportable disease. If your aunt goes in to see the doctor tomorrow and is told she has breast cancer, that must be reported by law to the federal government. Autoimmune diseases are not reportable diseases. Therefore, we really have no idea how big the problem is. Many scientists believe that the 24 million figure is vastly underreported.

How has Europe responded to the proliferation of untested chemicals?

Europe operates by what is called the precautionary principle, which says that if you have enough evidence to show that a product is probably doing harm, it behooves us to take that product off the market and do more studies before we bring it back on.

Europe has established a program called REACH (Registration, Evaluation and Authorization of Chemicals), and over the next 10 years, 30,000 chemicals will undergo safety testing. Guess who's paying for it? Not the taxpayer, the chemical companies. In this country, we are light years behind Europe in terms of public policy. We know that certain agents damage the immune system, but we keep saying, "We need more studies to prove it." Until it's harmed enough people like tobacco, we're just not going to do anything about it.

What can the average person do in daily life to reduce the threat?

If you think of the problem like a barrel that's too full, you can make small changes without feeling totally overwhelmed. One of the easiest things to get rid of are chemical cleaners. There are so many different nonchemical cleaners on the market now, there is almost no excuse not to clean green. Or make your own: Take one part vinegar, two parts water and a dash of lemon, you've got a pretty good cleaner. Shop for nontoxic cosmetics and use alternatives to pesticides.

We also know that diet can have a profound effect on the immune system. If you clean up your diet, your body has fewer foreign agents to assess. So eat fewer processed foods, fewer packaged foods, more organic fruits and vegetables. And we know that stress hormones play a key role in the onset of many autoimmune diseases. So lessening stress is crucial.

david.kohn@baltsun.com

Autoimmune disease

-In these ailments, the body mistakenly attacks its own tissues.

-Key autoimmune diseases include rheumatoid arthritis, multiple sclerosis, lupus, Type 1 diabetes, thyroiditis, Guillain-Barre syndrome and celiac disease.

-Twenty-four million Americans have an autoimmune disease, more than double the number with cancer.

-Diseases strike women more often; four of five patients in this country are women.

[Source: The Autoimmune Epidemic: Bodies Gone Haywire in a World out of Balance and the Cutting-Edge Science that Promises Hope]

Government Resources

The National Institute of Arthritis and Musculoskeletal and Skin Diseases NIAMS/National Institutes of Health once published an informative patient brochure on this topic called "Autoimmunity: Questions and Answers About Autoimmunity" (NIH Publication No. 02-4858). Unfortunately, they appear to have removed it from their servers, but because the document is not copyrighted and the NIAMS encouraged widespread distribution of the brochure, I did find it elsewhere online, see http://www.pfwmd.com/Documents/autoimmunity.pdf for details.

Also, to facilitate collaboration among various National Institutes of Health components, other Federal agencies, and private organizations with an interest in autoimmune diseases, the NIH established the Autoimmune Diseases Coordinating Committee in 1998, under the direction of the National Institute of Allergy and Infectious Diseases. [Note: The reason for it being assigned to this particular institute may have something to do with the amount of work allocated to each Institute, with NIAID being one of the least busy, but this was never acknowledged.] Anyway, the Coordinating Committee's Research Plan can be found at:
http://www3.niaid.nih.gov/about/organization/dait/PDF/dec2002_ADCC.htm

The Committee's last published report was March 2005, and can be found at:
http://www.niaid.nih.gov/publications/pdf/ADCCFinal.pdf

Finally, let me close by noting something you may not have known. While nearly 75% of the more than 23.5 million Americans who suffer from autoimmune disease are women, millions of American men suffer from these diseases, too. However, autoimmune diseases that develop in men tend to be more severe. For example, few can be treated by taking a simple pill each day to treat hypothyroidism, for example.

There are a few autoimmune diseases that men are just as or more likely to develop as women, including:

* Ankylosing spondylitis
* Type 1 diabetes
* Wegener's granulomatosis
* Psoriasis

Because of this, the American Autoimmune Related Diseases Association (AARDA) in April launched a new public service campaign. The "Men Get Autoimmune Diseases, Too" campaign consists of 30-second radio and television public service announcements (PSAs) and educational materials designed to raise awareness about the fact that, while women are disproportionately affected, these diseases do not discriminate when it comes to gender. Specifically, the PSAs inform men about the importance of knowing their family AQ.



"AQ is a play on IQ and stands for Autoimmune Quotient. It's about knowing how likely you are to develop an autoimmune disease given the prevalence of theses disease in your family," explained Virginia Ladd, president and executive director, AARDA.

"Much more research and many more research dollars are needed for basic research to determine just how gender and sex hormones influence autoimmunity in men; for epidemiological studies to determine the exact number of men who suffer with ADs; and for clinical studies to better understand just how these diseases manifest in men as opposed to women," added AARDA's Ladd.