January 06, 2011
Your Autoimmune Disorder Risks
Should you care about the rate of advance of biomedical research and biotechnology? Well, your odds of suffering from some really undesirable disorders are high enough that you really would be better off with cures for all these maladies. You odds of getting an assortment of autoimmune disorders:
The adult lifetime risk in the United States of having some kind of inflammatory autoimmune disease is 8.4 percent for women and 5.1 percent for men. Based on year 2000 population figures, that means one woman in 12 and one man in 20 will develop one of the conditions in their lifetime. The authors consider that a substantial risk and say their findings should encourage more research on the value of early diagnosis and intervention for people with increased genetic risk of arthritis. They hope the new figures will help in counseling patients and in fundraising efforts to find improved treatments.
The figures below reflect lifetime risk for the respective diseases, based on the Mayo findings.
|Rheumatoid Arthritis (RA)
|| 3.6% or 1 in 28
|| 1.7% or 1 in 59
|Systemic Lupus Erythematosus
|Giant Cell Arteritis
|Primary Sjögrens syndrome
Keep in mind those are just the autoimmune disorders. Plenty of chronic kidney, liver, digestive tract, skin, neurological, and other disorders could lie in store in your future. Unfun.
The threat of future diseases makes me support better policies that increase market incentives for treatment development. For example, policy changes that could increase the returns on drug development could help you 10, 20, 30, 40 years from now.
Listening to Robb Wolf's podcasts, I get the impression that autoimmune disorders respond well to a paleo diet. I think research into developing drugs to treat diseases has much less potential return than looking into dietary interventions to treat diseases. I think a focus on drug development is misguided because it captures resources which would otherwise go into diet research.
Thing is, many 'autoimmune' disorders are actually a result of undiagnosed dietary allergy (often gluten or dairy). Diabetes can be an autoimmune disorder, too (your immune system starts attacking the islets of langerhans on your pancreas). I don't think it makes sense to approach these first and foremost as pseudorandomly inflicted ailments that then need to be cured; rather the risk factors (genetic, diet and environmental) need to be identified so that the more vulnerable can do appropriate lifestyle modifications.
This list includes only rheumatic autoimmune diseases, not autoimmune diseases in general. Your chances of being afflicted by one of the many autoimmune disorders are higher than claimed here.
I have myasthenia gravis, muscle autoimmune disease 1 or 2 in 10,000. Best understood of autoimmune diseases but cause is unknown
Hashimoto's Thyroidosis. About as common as dirt -- something like 20% of all women 50 and up...
Higher intake of "omega-3" fats (EPA/DHA, found in fatty fish, grass-fed meat, and even to a lesser extent in factory-farmed beef) and lower intake of "omega-6" fats (the misnamed "vegetable" oils...actually grain oils), derived from grains, beans, and seeds) are anti-inflammatory and immunomodulatory in hundreds of different ways.
Not to mention that, as bbartlog noted, many people have IgG immune reactions to gluten even though they don't have frank celiac disease. Range is from under 1% to 15%, depending on ethnicity and location.
Paleolithic ratios of n-3:n-6 consumption were 1:1-1:2, pre-Industrial Revolution ratios were appx. 1:4, and post-WWII ratios (after we started extracting seed oils, like corn, soybean, and cottonseed via hexane processing) are 1:20 or higher. It's easy to eat a modern diet with no n-3 fats at all!
So it's not surprising that a "paleo" diet, which increases intake of n-3, decreases intake of n-6, and drops grains entirely, would result in a lower risk of autoimmune disease.
The reason more women than men suffer from autoimmune disease is because androgenic steroid hormones decrease immune response, just as corticosteroids (e.g. prednisone) do. This is why men, if they develop such disease, tend to develop it after the age of 40, when T levels have plummeted.
Amplifying comments above, yeah: this list significantly underestimates the actual incidence of autoimmune disorders. The CDC only commented on *inflammatory* or as tom swift said, 'rheumatic', autoimmune disease. That does not include many important ones - notably Type 1 (juvenile) Diabetes, myasthenia gravis, celiac disease, Graves and Hashimoto's diseases of the thyroid (the kind that afflicts George HW Bush), Guillan-Barre (Andy Griffith has this), MS, many diseases of the kidneys (like my own Goodpasture's Syndrome) and on and on.
In other words, we're even more doomed than you think! :)
As a "sufferer" of psoriasis, which now dominates my body, I feel compelled to respond to those who insist that these auto-immune diseases are treatable merely by diet. Horseshit.
I have experimented with different diets over the last year and a half in an effort to avoid medicinal treatments. Nothing, and I mean NOTHING worked. You folks who think "Oh, well with a more 'pure' form of living and eating and a healthier lifestyle, one could avoid such maladies." Your sophistry is rooted and arrogance. You don't know anything, yet you opine.
It is my well-informed (and reasoned) desire for the pharma companies to keep doing what they are doing, and provide research and results with less governmental constraint, which constraint is often due to the sophists who know nothing yet regulate and thus impede true progress.
V has a point. The truth is that people with every illness have tried almost all conceivable diets. Diet has a place in the treatment of some of these diseases. Usually quite a small place. Prevention is of course a different question and one that can only be answered by high quality epidemiology.
V: I'm sorry that you're suffering, and I know there are a lot of smug quacks who insist that it's your fault for not eating enough [some quasi-natural fad substance]. No one has said that changing diet will magically cure anything! For example, the phrase I used is "...would result in a lower risk of autoimmune disease."
Note that diet is primarily a tool for not developing autoimmune disease in the first place, as implied by my statement. Once your body decides to sensitize to a self-antigen, it's very, very difficult to get it to stop. And like you, I hope we can continue to make medical progress...because right now, the drugs aren't actually addressing the problem, which is how to desensitize your immune system to a self-antigen. All they do is knock out various parts of the immune system or ameliorate symptoms...even the $20,000 per year biologicals.
However, I did (and do) feel compelled to point out that there are dietary patterns that can lessen your risk of developing these syndromes in the first place, if you're fortunate enough to not have done so already.
There is anecdotal evidence that diet affect psoriasis. Four people in this thread said that diet played a role in reduction of their psoriasis.
Note that OTC supplements were also used.
And then for scientific background, Loren Cordain writes about psoriasis:
Although no clinical trials to date have tested the
efficacy of treating psoriasis patients with the Paleo
Diet, a substantial amount of evidence exists
to indicate that it would be therapeutic. I have
previously shown how diet may be linked to the
etiology and promotion of rheumatoid arthritis via
a process of 3-way molecular mimicry in which
the immune system mistakenly attacks self tissue
because of antigens leaking through from the gut
(2). I believe a similar situation may exist for
psoriasis patients. Here’s why:
There is no doubt that psoriasis is largely a
cross reactive T-cell mediated disease (3) involving
environmental agents that elicit the disease in genetically
susceptible individuals. The major genetic
determinant of psoriasis is the major histocompatibility
complex with the HLA-Cw*0602 allele showing
the strongest association (4). As we pointed out
in our recent paper (2), peripheral activation of Tcells
in the gut likely underlies many autoimmune
diseases, including psoriasis. Dietary lectins from
cereals such as wheat (wheat germ agglutinin --
WGA) or from beans phytohemagglutinin (PHA) increase
intestinal permeability and allow intestinal
pathogens and the lectins themselves continual peripheral
immune system stimulation (2). Psoriasis
patients show increased intestinal permeability (5)
and gluten free diets improve disease symptoms in
psoriasis patients (6,7). Elevated inflammatory cytokine
(INF-gamma, TNF-apha, IL-2) are hallmarks of
psoriasis (8) & both WGA and PHA stimulate overproduction
of these cytokines in peripheral mononuclear
cells (2). WGA, PHA and PNA (peanut agglutinin)
all rapidly cross the intestinal barrier and appear
in plasma in physiological concentrations within 1-3
hours after ingestion (2,9). I believe that by eliminating
all grains, all legumes (peanuts are legumes)
and dairy products and by increasing the n-3 content
of the diet (10), many patients with psoriasis
may have amelioration or remission of disease
symptoms. Increased dietary vitamin D or sunlight
exposure may also prove therapeutic (11).
> Note that diet is primarily a tool for not developing autoimmune disease in the first place, as implied by my statement.
You almost certainly don't have randomized controlled trials to show that. Which is not to say I've never advocated anything without RCTs on my side. I did, however, note my lack of RCRTs when I did so.
> And like you, I hope we can continue to make medical progress...because right now, the drugs aren't actually addressing the problem, which is how to desensitize your immune system to a self-antigen. All they do is knock out various parts of the immune system or ameliorate symptoms...even the $20,000 per year biologicals.
This is quasi obscurantist at best. The diseased person couldn't care how methotrexate or azathioprine work, he cares about whether and how much they work.
Of course, that doesn't mean a line of research and theory favored by researchers who are MTX and azathioprine fans is as good as, or has as much future potential as, your line of research. Certainly not. But give MTX and azathioprine their due in the practical, right-now realm.
> The reason more women than men suffer from autoimmune disease is because androgenic steroid hormones decrease immune response, just as corticosteroids (e.g. prednisone) do. This is why men, if they develop such disease, tend to develop it after the age of 40, when T levels have plummeted.
That's an excellent theory, based on true facts. Compared to a randomly-assembled theory, it has much higher odds of being fact. Whether it is true, though, we'll have to see.
"The diseased person couldn't care how methotrexate or azathioprine work, he cares about whether and how much they work."
I have not and am not discounting their effects, and you're correct: they're the best we've got right now.
However, they do not cure any autoimmune disease, and neither does any other drug, even the new ones like etanercept and infliximab. Right now we cannot cure any autoimmune disease, because we can't desensitize the immune system to self-antigens. All we can do is depress the immune system generally (corticosteroids, azathioprine), suppress purine metabolism (methotrexate, azathioprine), or inhibit TNF-alpha (the biologicals)...each of which has undesirable, even toxic, side effects.
On that note, DHA supplementation has been shown to inhibit TNF-alpha in vivo by up to 76%, without the side effects of the biologicals (link). So there is indeed clinical evidence for the role of diet in autoimmune disease.
Note that I am not arguing for the replacement of prednisone/MTX/AZA with dietary therapy: it's just another weapon to use in the fight.
"You almost certainly don't have randomized controlled trials to show that."
No, I don't, but it's a common-sense application of the facts, which are that (as far as we know) food is no better than drugs at desensitizing our bodies to self-antigens.