Environmental Influences and Autoimmune Disease

by | Sep 27, 2014 | Blog Post | 0 comments

There is an ongoing buzz in the medical community about environmental triggers and their effect on autoimmune disease. I can anecdotally attest that environmental factors play a major role in autoimmune disease, as I have watched my Lupus go from a terrible, almost unbearable beast to a manageable, often forgotten and minor inconvenience. This shift occurred after embracing a healthier, more holistic lifestyle largely influenced by things like nutrition, toxic exposure, stress management and modifying ideologies. The scientific research community tends to agree that environment has a tremendous impact on the expression and exacerbation of autoimmune diseases. I believe this is wonderful news, as it brings us that much closer to harmony between Eastern and Western medical philosophies.

Let’s back up and briefly define what autoimmune diseases are. Normally, our immune system protects us from foreign invaders through complex, highly organized biological processes. In general, our immune system does a wonderful job of recognizing the bad guys (the foreigners or pathogens) from the good guys (our own tissues). However, sometimes there is a breakdown in this ‘immune tolerance’ (or ability to recognize self from non-self), and the immune system begins to attack its own self leading to inflammation and tissue destruction. Autoimmune diseases as a whole tend to affect women more than men and can be organ-specific (affecting only one organ) or systemic (affecting multiple organs). Currently, over 80 to100 autoimmune diseases have been identified. This surplus in number of autoimmune diseases is related to the fact that the immune system can attack any organ, gland or tissue in the body and depending on where the immune system strikes, will ultimately determine how the disease will manifest and what kinds of symptoms a person will have. For example, autoimmune attack of specific components of the brain may lead to Multiple Sclerosis (MS), an organ-specific condition characterized by numbness and tingling in the limbs or trunk, loss of vision or complete paralysis. While an autoimmune attack of predominantly the joints may lead to Rheumatoid arthritis, a systemic autoimmune condition that can lead to joint pain and stiffness, fatigue and disease in the heart, lungs, skin, eyes and everything in between. The very unfortunate thing about any of these autoimmune conditions is that there is still an incredible lack of understanding and knowledge on the part of healthcare providers with regard to how to identify and appropriately treat autoimmune disease. This coupled with poor diagnostic testing and extensive variability in autoimmune symptoms will often lead to many years of misdiagnosis or no diagnosis at all. This leaves patients depressed, withdrawn and sick for a lifetime.

Scientists also agree that genetics plays a significant role in the development of autoimmune disease. They have identified multiple (over 200) polymorphisms or variations in genes that contribute to autoimmune disease1. Further, we do know that autoimmune diseases cluster in families, suggesting the influence of genetics. Still, scientists also agree that genetics cannot fully explain the wide array of variance in autoimmune disease1. Identical twin studies have alluded to another player in the autoimmune game evidenced by the fact that even though identical twins have the same genetic makeup, only one may develop an autoimmune condition while the other will not. Environment has been cited as the missing link.

So what am I saying? I’m saying that there is most likely some combination of genetic susceptibility along with certain environmental exposures that lead to autoimmune disease development. I don’t know about you, but to me, this is a good thing. I see this as an opportunity to be able to make changes in behavior and lifestyle that could positively impact our expression of disease. There are many potential environmental factors that are being explored as triggers to autoimmune disease. We will discuss several of these below.

POTENTIAL ENVIRONMENTAL INFLUENCES

Toxins

Toxic exposure has gotten a great deal of attention over the years with regard to its role in autoimmunity. Occupational exposure probably gives us the best indication of the impact that chemicals have on the immune system. For example, silica and asbestos have both been associated with rheumatoid arthritis (RA), system lupus erythematous (SLE) and scleroderma in miners and residents from Libby, Montana,2 a town famous for industrial asbestos poisoning of the locals. Likewise, vinyl chloride, solvents, benzenes and trichloroethylene have all been mentioned as industrial culprits associated with the development of scleroderma (also known as systemic sclerosis)3. Of particular interest to females that are considering breast augmentation, silicone implants have been implicated in causing diseases similar to scleroderma. Additionally, lupus antibodies have been found in females with silicone implants, with subsequent disappearance of the antibodies once the implants were removed4. Finally, heavy metals including mercury, silver and gold have been implicated in autoimmunity through various mechanisms1.

Medications

The role of pharmaceutical drugs in the development of autoimmune disease should come as no surprise. Currently, 10% of SLE cases are drug-induced and more than 100 drugs are known to cause lupus-like disease1. That’s staggering! What’s even more interesting is that the diseases disappear once the drug is removed. Research continues to exam the mechanisms by which these drugs are inciting the immune system with data consistently pointing to epigenetic mechanisms1 (epigenetics is the study of certain mechanisms that are involved in turning genes on and off).

Infectious Agents

Viruses and some bacteria are famous for leading to or exacerbating autoimmune disease. The most famous of these is the Epstein-Barr virus (EBV). EBV is known to infect B-cells- immune cells that are integral in producing antibodies to foreign invaders. EBV is associated with many autoimmune conditions including SLE, MS, RA, Sjogren’s, autoimmune thyroiditis and autoimmune hepatitis (Please see Table 1 for more information on specific autoimmune conditions). It may be of interest to note that one of the most common mechanisms by which infections lead to autoimmunity is through a process known as molecular mimicry. Molecular mimicry refers to the scenario where the infectious agent looks very similar in molecular structure to that of our own organs, glands or tissues leading to confusion on the part of our immune system. As the immune system tries to rid the body of the infection, it may also accidentally attack its own self. Tricky little devils, aren’t they.

Stress

The mechanisms by which stress lead to and perpetuate autoimmune disease is not well-understood, but may be related to the stress hormone, cortisol. Cortisol is an important anti-inflammatory hormone that when released chronically (or when taken as a medication chronically) can lead to a whole host of unwanted symptoms including abdominal obesity, high blood sugar, anxiety, depression, heart disease, digestive problems and sleep difficulties. Autoimmune conditions appear to respond very positively to stress-response techniques designed to calm both the body and the mind.

Diet

Diet has a clear role in the activation of genes involved in immune regulation as well as an effect on the inflammatory system in the body. Celiac disease offers a nice example of how genetic susceptibility with an environmental trigger can contribute to the development of autoimmune disease. It has been well established that Celiac disease is associated with having certain genetic markers, specifically the genes HLA-DQ2 or HLA-DQ8. Further, one of the primary risk factors for Celiac disease is having a first degree relative with Celiac disease. Gluten, a protein found in wheat and wheat-like grains, is the environmental trigger that ultimately leads to an immune reaction in the intestines and subsequent symptomology observed in Celiac disease. Currently, the treatment of choice for Celiac disease is a 100% gluten-free diet.

Milk and wheat constituents provide another great example of diet as a potential environmental risk factor in the development of autoimmune disease. Research has suggested that early infant ingestions of cow’s milk may lead to the development of type 1 diabetes5. Similarly, wheat proteins, in particular, the gluten molecule, have been implicated in multiple autoimmune conditions including celiac disease (as discussed above), type 1 diabetes6 and autoimmune thyroid conditions7,8. I suspect that there is a relationship with many other autoimmune conditions as well. In clinical practice, I have observed that most, if not all, autoimmune patients are able to control their symptoms better with a gluten-free diet.

Hormones

Lastly, hormones play an important role in autoimmune disease as well. Estrogen is known to enhance the immune response, while testosterone and progesterone are believed to suppress it. Further, estrogen receptors are found on many immune cells. Females have a greater susceptibility to autoimmune disease than men and may be related to the fact that they have stronger immune responses than men1. Diligent medical professionals are aware that oral birth control pills will exacerbate disease in autoimmune patients and never advise these medications.

There appears to be mounting evidence of the tremendous role that our environment, lifestyles and behavior has on autoimmune disease development and/or exacerbation. Nonetheless, there is still more work to be done. For now, I can confidently say that a healthful diet of abundant vegetables, adequate and high-quality protein and scarce sugar and processed foods, along with nutritional supplementation, appropriate detoxification and lifestyle management techniques that address sleep, stress and positive behavior are powerful tools, under our control that will give autoimmune patients a fighting chance!

Table 1. Common Autoimmune Diseases and Symptoms (This list is not all-inclusive)

Autoimmune Disease Symptoms
Autoimmune hepatitis 

The immune system attacks and destroys the liver cells. This can lead to scarring and hardening of the liver, and possibly liver failure.

  • Fatigue
  • Enlarged liver
  • Yellowing of the skin or whites of eyes
  • Itchy skin
  • Joint pain
  • Stomach pain or upset
Celiac disease 

A disease in which people can’t tolerate gluten, a substance found in wheat, rye, and barley, and many other products. When people with celiac disease eat foods or use products that have gluten, the immune system responds by damaging the lining of the small intestines.

  • Abdominal bloating and pain
  • Diarrhea or constipation
  • Weight loss or weight gain
  • Fatigue
  • Missed menstrual periods
  • Itchy skin rash
  • Infertility or miscarriages
  • Depression and anxiety
  • Heart Disease
Diabetes type 1 

A disease in which your immune system attacks the cells that make insulin, a hormone needed to control blood sugar levels. As a result, your body cannot make insulin. Without insulin, too much sugar stays in your blood. This can lead to damage of the eyes, kidneys, nerves, and gums and teeth. It can also lead to heart disease.

  • Being very thirsty
  • Urinating often
  • Feeling very hungry or tired
  • Losing weight without trying
  • Having sores that heal slowly
  • Dry, itchy skin
  • Losing the feeling in your feet or having tingling in your feet
  • Having blurry eyesight
Graves’ disease (overactive thyroid) 

A disease that causes the thyroid to make too much thyroid hormone.

  • Insomnia
  • Irritability
  • Weight loss
  • Heat sensitivity
  • Sweating
  • Fine brittle hair
  • Muscle weakness
  • Light menstrual periods
  • Bulging eyes
  • Shaky hands
  • Sometimes there are no symptoms
Hashimoto’s Thyroiditis (underactive thyroid) 

A disease that causes the thyroid to not make enough thyroid hormone.

  • Fatigue
  • Weakness
  • Weight gain
  • Sensitivity to cold
  • Muscle aches and stiff joints
  • Facial swelling
  • Constipation

 

Inflammatory bowel disease (IBD) 

A disease that causes chronic inflammation of the digestive tract. Crohn’s disease and ulcerative colitis are the most common forms of IBD.

  • Abdominal pain
  • Diarrhea, which may be bloody
  • Rectal bleeding
  • Fever
  • Weight loss
  • Fatigue
  • Mouth ulcers (in Crohn’s disease)
  • Painful or difficult bowel movements (in ulcerative colitis)
Multiple sclerosis (MS) 

A disease in which the immune system attacks the protective coating around the nerves. The damage affects the brain and spinal cord.

  • Weakness and trouble with coordination, balance, speaking, and walking
  • Paralysis
  • Tremors
  • Numbness and tingling feeling in arms, legs, hands, and feet
  • Symptoms vary because the location and extent of each attack vary
Myasthenia gravis (MG) 

A disease in which the immune system attacks the nerves and muscles throughout the body.

  • Double vision, trouble keeping a steady gaze, and drooping eyelids
  • Trouble swallowing, with frequent gagging or choking
  • Weakness or paralysis
  • Muscles that work better after rest
  • Drooping head
  • Trouble climbing stairs or lifting things
  • Trouble talking
Psoriasis 

A disease that causes new skin cells that grow deep in your skin to rise too fast and pile up on the skin surface.

  • Thick red patches, covered with scales, usually appearing on the head, elbows, and knees
  • Itching and pain, which can make it hard to sleep, walk, and care for yourself
  • May have a form of arthritis that often affects the joints and the ends of the fingers and toes. Back pain can occur if the spine is involved.
Rheumatoid arthritis 

A disease in which the immune system attacks the lining of the joints throughout the body.

  • Painful, stiff, swollen, and deformed joints
  • Reduced movement and function
  • Fatigue
  • Fever
  • Weight loss
  • Eye inflammation
  • Lung disease
  • Lumps of tissue under the skin, often the elbows
  • Anemia

 

Scleroderma 

A disease causing abnormal growth of connective tissue in the skin and blood vessels.

  • Fingers and toes that turn white, red, or blue in response to heat and cold
  • Pain, stiffness, and swelling of fingers and joints
  • Thickening of the skin
  • Skin that looks shiny on the hands and forearm
  • Tight and mask-like facial skin
  • Sores on the fingers or toes
  • Trouble swallowing
  • Weight loss
  • Diarrhea or constipation
  • Shortness of breath
Sjögren’s syndrome 

A disease in which the immune system targets the glands that make moisture, such as tears and saliva.

  • Dry eyes or eyes that itch
  • Dryness of the mouth, which can cause sores
  • Trouble swallowing
  • Loss of sense of taste
  • Severe dental cavities
  • Hoarse voice
  • Fatigue
  • Joint swelling or pain
  • Swollen glands
  • Cloudy eyes
Systemic lupus erythematosus 

A disease that can damage the joints, skin, kidneys, heart, lungs, and other parts of the body. Also called SLE or lupus.

  • Fever
  • Weight loss
  • Hair loss
  • Mouth sores
  • Fatigue
  • “Butterfly” rash across the nose and cheeks
  • Rashes on other parts of the body
  • Painful or swollen joints and muscle pain
  • Sensitivity to the sun
  • Chest pain
  • Headache, dizziness, seizure, memory problems, or change in behavior

References

  1. Javierre BM, et al. Environmental Triggers and Epigenetic Deregulation in Autoimmune Disease. Discovery Medicine, 12(67):535-545, 2011
  2. Schmidt CW. Environmental Factors in Autoimmune Disease. Environmental Health Perspectives, 119(6):A249-253, 2011
  3. Bovenzi M, et al. Scleroderma and occupational exposure. Scand J Work Environ Health, 21:289–92, 1995
  4. Piligian G, Lee H. Possible Environmental Triggers Associated with Autoimmune Diseases. Hospital for Special Surgery- Adapted from a presentation given at an SLE workshop, 2012
  5. Vojdani A. A Potential Link between Environmental Triggers and Autoimmunity. Autoimmune Diseases. Vol. 2014, Article ID 437231, 18 pages, 2014
  6. Sumnik Z, et al. High Prevalence of Coeliac Disease in Siblings of Children with Type 1 Diabetes. European Journal of Pediatrics. 164(1):9-12, 2005
  7. Akcay MN, et al. The Presence of Antigliadin Antibodies in Autoimmune Thyroid Diseases. Hepatogastroenterology. 50(2): cclxxix-cclxxx, 2003
  8. Hakanen M, et al. Clinical and Subclinical Autoimmune Thyroid Disease in Adult Celiac Disease. Digestive Diseases and Sciences. 46(12): 2631-2635, 2001

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