The Autoimmune Epidemic: Bodies Gone Haywire in a World Out of Balance--and the Cutting-Edge Science that Promises Hope (No Series) (34 page)

GLUCOSAMINE.
More familiar to many of us, glucosamine, the over-the-counter natural product that has been touted to help with joint and cartilage problems associated with arthritis, may also provide some relief to individuals with multiple sclerosis. Using a mouse model of MS, neurologists recently found that doses of glucosamine similar to those commonly taken as supplements dramatically delayed the onset of MS symptoms and improved the ability of lab animals to walk and move. Researchers believe that glucosamine may prove useful in human trials for those suffering from MS.

PROBIOTICS.
One area in which a great deal of research has been done in autoimmune-disease patients is that of probiotic supplementation. Preparations of living microbial cells that are commonly referred to as “friendly bacteria” are prescribed to repair the gut in patients with inflammatory autoimmune diseases such as Crohn’s disease and ulcerative colitis. Ten years ago the concept that a food ingredient such as probiotics—commonly found in yogurt—could aid in fighting autoimmune disease was scoffed at by most medical professionals. Yet today you can find more than three hundred studies on PubMed linking probiotics to the treatment of inflammatory bowel disease. It has become well accepted, says Mullin, “that gut bacteria help drive inflammatory bowel disease and inflammation, and over the past decade an increasing number of studies indicate that by changing the mix of bacteria, probiotics may help patients with these autoimmune diseases of the gut significantly.”

The human gut is full of bacteria—most of it beneficial. But lacking a complete set of these healthy bacteria can interfere with food digestion and fighting off illness and inflammation. In inflammatory bowel disease studies, researchers reintroduce these positive bacteria and allow them to repopulate the gut. Like other natural supplements—such as vitamin D and antioxidants, which modulate pro-inflammatory cytokines—probiotics often produce their own anti-inflammatory chemicals. Indeed, recent research finds that therapy with the probiotic
Lactobacillus reuteri
directly modulates pro-inflammatory cytokine production in mice, and a recent paper published in the
American Journal of Gastroenterology
showed that the majority of patients taking a probiotic mixture of eight bacteria, known as VSL#3, for six weeks improved their ulcerative colitis. The proper balance of intestinal flora also plays a strong role in preventing leaky gut syndrome, which can spark the body toward an allergic or autoimmune response. Researchers believe this is why supplementation with probiotics has also shown promising results in treating the symptoms of rheumatoid arthritis.

For Gerry Mullin, a combination of probiotics, antioxidants, omega-3s, a whole-foods diet, and herbal approaches—coupled with “prayer and determination”—proved critical in taming and changing the course of his disease.

As consumers begin to demand more options for difficult-to-treat autoimmune diseases, biotech companies are increasingly turning toward what industry and consumers refer to as “nutraceuticals”—supplements that they hope will compete with prescription drugs. Likewise, research institutes that have long specialized in conventional, Westernized medical care are starting to investigate whether plant extracts and herbal preparations may yield promising results for patients. The Mayo Clinic, for instance, recently announced that they are decoding—using “sophisticated data mining techniques”—ancient, historical herbal texts to help develop potential new drugs for the future. Using nontraditional, ancient medical information taken from seventeenth-century texts, they have pinpointed certain herbal extracts to be “invaluable sources of healing agents.”

At other institutions around the country, researchers are now studying an array of supplements and natural remedies that may ameliorate autoimmune activity and inflammation, including green tea extract (recently found to be a potent anti-inflammatory that provides therapeutic benefits to people with rheumatoid arthritis), grape seed extract, evening primrose oil, avocado/soybean extract, willow bark, ginger, devil’s claw (a South African plant long touted for its anti-inflammatory properties), cat’s claw (a Peruvian remedy found in the cat’s claw vine), and boswellia (a remedy extracted from a tree that grows in India).

Again, anyone wanting to try any supplement, nutrient, or vitamin should be cautious. Almost every day conflicting studies emerge on the properties of various foods and supplements. One day, vitamin E is good; the next, we find out that the benefits of vitamin E supplements have been oversold. Large doses of some supplements such as vitamin A, vitamin B
₆
and vitamin E may even be harmful. If you are concerned about a particular nutrient or supplement, in addition to discussing it with your health-care provider, peruse the National Institutes of Health Office of Dietary Supplements website for data on a wide range of dietary supplements and their risks and safety (www.ods.od.nih.gov). You can also download the USDA’s free nutrient database software (go to www.ars.usda.gov/ba/bhnrc/ndl and hit Download Software) to get in-depth information about the nutrients and vitamins present in the food you eat. The site gives you a detailed breakdown of nearly seven thousand common foods. Plug in an item, from a cup of arugula to a turkey sandwich, and the program gives you an analysis of more than thirty nutrients. It also covers many kinds of processed and fast foods in greater detail than you’ll find on most packages or menus.

A similar resource is available for helping you to make choices about what type of seafood to eat and how much. Go to http://www.gotmercury.org and enter your weight and the quantity and type of seafood you will eat during the coming week, then hit Calculate. The calculator will tell you whether your exposure to mercury through consuming a particular fish in a specific amount at your given weight constitutes a low, moderate, or high toxicity risk, based on current EPA standards.

UNDERSTANDING THE STRESS CONNECTION

We’ve all heard by now that stress is toxic to our immune system. “First-Year College Students Who Feel Lonely Have a Weaker Immune Response to the Flu-Shot,” “Asthmatic Responses to Allergens Worsen During Stressful Times,” “Marital Strain Increases Women’s Risk of Death, Heart Disease,” and “Arguments Slow the Body’s Ability to Heal from Wounds” are all recent newspaper headlines that warn that stressful events can derail the basic function of our immune cells. Even stressful events that happened in our childhood can take a costly long-term toll on our health: people who experience significant traumas as children have an increased risk of developing immune-system problems as adults, including lowered white blood cell counts and elevated biomarkers of inflammation. Likewise, stressful events as adults—getting divorced, being physically assaulted, losing a job—take a toll on physical health even many years after the fact. One recent study found that those who had suffered more serious, negative life events had a 25-percent higher chance of dying within the next eight years.

In autoimmune disease, the link between stress and disease is profound. Stressful events are associated with an increased risk of having MS relapses, and periods of high stress are linked to the onset and worsening of rheumatoid arthritis. One startling study bears this out all too starkly: parents who have suffered the loss of a child are 50 percent more likely to develop multiple sclerosis than parents who’ve never lost a child—and the risk of developing MS spikes highest among those parents who lost a child unexpectedly.

What happens in our immune systems to cause this cellular cascade where psychological stress can lead to a malfunctioning immune system? When we are stressed, our adrenal glands produce several hormones, including adrenaline and cortisol. The stress response starts in the hypothalamus, a part of the brain that also regulates body temperature, respiration, hunger, sleep cycle, sexual function, and blood pressure. In addition to all that, the hypothalamus works as a kind of on-duty internal alarm system, constantly surveying the world around us, trying to ferret out any signs of impending danger. When something stressful—something that feels potentially unsafe—occurs, the hypothalamus sends an instant warning alert to the adrenal glands, which in turn flood our bloodstream with adrenaline. Adrenaline increases our heart rate and sends more blood into our muscles and added oxygen to our brains to keep us quick on our feet and help focus our attention on the crisis at hand.

The hypothalamus also sends a signal to the pituitary gland in the brain, which triggers the adrenal gland to flush the body with the stress hormone cortisol. In a short-term stressful situation—when you suddenly have to veer away from an oncoming car on the highway, or leap to scoop up a toddler who is about to tumble down the stairs, or flee from a house that’s on fire—coritsol is critical to survival, preparing us for “fight or flight,” helping us to take action with the energy, determination, and speed that such a situation requires. This hormonal rush can happen all in the few seconds it might take to slam on the brakes of your SUV to keep from hitting a stray dog meandering across the highway. When the stressful event ends, your adrenals send the message back to your hypothalamus to tell it to stop producing extra cortisol and adrenaline so that your heart rate, breathing, and perspiration levels can subside to normal. That’s how the stress response is meant to work: it gets turned on when needed—and then it gets turned off quickly.

However, under chronically demanding conditions—the kind of unrelenting psychological stressors that are the standard menu of modern life such as looming bills, fraught relationships, worries over children, caregiving for elderly parents, work crunches, and nonstop schedules, or all of the above rolled into one—heightened levels of cortisol are repeatedly pumped through the body. These stressors are rarely as life threatening as a car collision, but we can feel so anxious and overwhelmed in the face of them that the body really can’t tell whether it’s dealing with an actual emergency or not. Unfortunately, it just doesn’t take very much to switch on the stress response. A deadline crunch or having a spat with your mother can both trigger it into overdrive.

Cortisol plays a central role in the immune system’s responses and activity. The immune system’s response is so potent that it requires intricate regulation to ensure that it is not too powerful and yet is strong enough to do the job of keeping the body safe. Under stress, cortisol mobilizes all major types of immune cells to battle stations in the body—primarily along the lymph nodes. That’s great when we are trying to fight off infections and other diseases. But when stress turns chronic and an increased number of immune cells are ushered to sentry posts in the body too frequently, it can put too much wear and tear on the immune system. Overwhelmed by stress hormones and chemicals, immune cells never get a chance to recover from the constant barrage of cortisol, making us incapable of responding to new stress with even a slight burst of cortisol. We’re all tapped out. The faucet is leaking a steady stream of cortisol, yes, but we can’t get a full-force stream when we desperately need one. Our immune cells become so beleaguered that they become less able to react quickly to clear away pathogens—which is why research shows that you’re more likely to catch colds and infections if you’re in a troubled marriage.

Prolonged levels of heightened cortisol can not only lead to an underfunctioning immune reaction, but can also indirectly stimulate an autoimmune response. Stress hormones and chemicals travel to the immune system through the bloodstream and nerves and can dramatically alter how immune cells work. Cortisol helps to regulate our immune-system response not only by turning on the immune response, but also by turning it off. When cortisol keeps being pumped out because of daily anxieties and stressors, we stop producing sufficient cortisol to signal the immune response to turn off. This increases the likelihood that the immune system will go into erratic overdrive, that mistakes will be made and autoantibodies will attack the body itself.

In numerous studies, people who experience grinding, ongoing stress show higher levels of inflammatory cytokines in their blood compared to nonstressed individuals. One research study found that those experiencing chronic stress had higher levels of interleukin-6, or IL-6, which are pro-inflammatory cytokines that act as signaling messengers between cells of the immune system and which can whip up the immune cells to turn against the body itself. You might remember that this is the same inflammatory cytokine that Douglas Kerr, associate professor of neurology at Johns Hopkins School of Medicine, found in elevated levels in the spinal fluid of MS patients. Indeed, Kerr found that in patients with MS and transverse myelitis, the level of IL-6 proteins in their blood closely correlated with the severity of their paralysis. The same cytokine activity now being measured to help diagnose MS is also present in higher levels in those going through chronic stress.

Of course, one might ask which came first, the chicken or the egg? Is stress a contributing factor that leads to disease—or does disease lead to stress? The answer is both. For patients with autoimmune disease, stress produces a vicious cycle. Chronic illness is in and of itself an ongoing stressful event. In one recent report on what helps to secure human happiness, psychologists found that although those who suffer the loss of a spouse experience a great deal of stress, they eventually return to what psychologists refer to as their own personal “set point” of well-being. Over years, they become just as satisfied with life as they were prior to their spouses’ dying. But those who experience chronic physical illness or major setbacks in physical well-being tend not to rebound as easily; long-term illness may result in significant, lasting decreases in one’s personal sense of life satisfaction.