The Autoimmune Spectrum: Does It Exist, and Are You on It?
Autoimmunity—which affects three quarters more women than it does men—encompasses a range of conditions and diseases that involve the immune system mistakenly attacking the body’s own organs, tissues, and cells. Traditional medicine often focuses on individual autoimmune conditions and symptoms, while functional medicine generally takes a wider view, says Dr. Will Cole—a functional medicine practitioner with a doctorate of chiropractic from Southern California University of Health Sciences. What’s interesting about Cole’s Pittsburgh-based practice is that he works with patients around the country–and world–in places where some medical tests aren’t readily available. To work with him, you have to be under the care of a primary care physician—so it’s a real partnership with traditional medicine. Cole is clear that the goal of his practice is to promote health and optimal function, and not to diagnose/treat diseases or replace the necessity of your primary M.D.
Cole, who focuses on what he calls the autoimmune-inflammation spectrum, explains that by the time most people are diagnosed with an autoimmune disease, their immune systems have already destroyed a significant amount of their body: “This amount of autoimmune-inflammation attack doesn’t happen overnight.” While he aims to help people turn their health around before they hit this point, some patients come with already diagnosed autoimmune diseases (from Hashimoto’s to MS); many, he says, struggle with polyautoimmunity: “People with one autoimmune condition have a higher rate of suffering other autoimmune problems.”
Here, Cole talks about the autoimmune-inflammation spectrum, the symptoms that define it, what he’s found helpful for people across it, and how taking more control over our health (through diet and lifestyle changes) empowers us. He also shares his take on the role functional medicine can play in conjunction with conventional.
A Q&A with Will Cole, D.C.
What’s known about the progression of autoimmune diseases before diagnosis?
When someone is diagnosed with an autoimmune condition, they have already been experiencing autoimmune-inflammation for an average of about ten years.
New studies point to what many in functional medicine have been saying for decades: Food reactivity, like gluten sensitivity, is one end of a larger inflammation spectrum with autoimmune diseases like celiac on the other. Remember, there has to be significant destruction of your intestinal microvilli to be diagnosed as having celiac disease. But many people with celiac disease don’t even experience severe GI symptoms; research is now finding that celiac disease can manifest as neurological symptoms, such as anxiety, depression, and brain fog, as well as skin problems. This information should change the way we look at mental health—we should at least be seeing whether or not we can rule out autoimmune components in evaluating these issues.
“When someone is diagnosed with an autoimmune condition, they have already been experiencing autoimmune-inflammation for an average of about ten years.”
It’s been estimated only 5 percent of people with celiac are ever diagnosed. (There’s an estimated 3 million Americans with celiac disease who have no idea that they have it.) It’s also been estimated that at least 6 percent of us have gluten sensitivity or FODMAP intolerance because of chronic gut problems like small intestinal bacterial overgrowth (SIBO). (FODMAPS is an acronym for the fermentable sugars found in grain, dairy, legumes, and some fruits and vegetables like onions and garlic.)
Also, just because someone is experiencing autoimmune reactivity or pervasive inflammation, doesn’t mean their conditions will get to the severe point of diagnosis. Millions spend their lives stuck in autoimmune reactivity, being thrown from specialist to specialist.
Is this where you see functional medicine playing a role?
I believe functional medicine thrives in filling the gap for both diagnosed and undiagnosed people on the autoimmune-inflammation spectrum. There is no cure for diagnosed autoimmune conditions. Our goal in functional medicine is to give patients tools to manage their health. In many cases, there is a lot you can do to calm inflammation, balance the immune system, and, we hope, put your symptoms into remission. For the undiagnosed people struggling with autoimmune reactivity, there is also much you can do to take control of your health.
How does your functional practice work with conventional medicine?
Everything is always done in conjunction with our patients’ conventional M.D.s. Their doctor is managing their medications, while we focus on finding out what diet or lifestyle choices might be causing or contributing to their inflammation—or supporting the immune system through those same channels. By looking at stress, sleep, food, toxins, hormones, the microbiome, and genetic impairments, we are able to get a comprehensive view of their health puzzle. As patients get healthier, many physicians are able to reduce and eliminate medications over time. The mainstream doctors get excited as their patients get healthier: My patients often hear, “Whatever you are doing, keep doing it.” Who can be against someone regaining their health?
How do you assess autoimmunity? What tests do you use?
In general, I like to get the perspective of different labs to find out what is going on with the patient. The specific labs we run depend on the individual. We want to be diagnostically comprehensive but also efficient. Most of our patients are working class people and many of these labs are not covered by insurance, so while we of course don’t want to under-test, we don’t want to over-test either.
Some common labs we run are:
CRP: C-reactive protein is an inflammatory protein. It is also a surrogate lab to measure IL-6, another pro-inflammatory protein. They are both linked to chronic inflammatory health problems. The optimal range is under 1 mg/L.
Homocysteine: This inflammatory amino acid is linked to heart disease and destruction of the blood-brain barrier and dementia; and is also commonly seen with people struggling with autoimmune problems. The optimal range is less than 7 Umol/L.
Microbiome labs: We look to assess gut health, where around 80 percent of our immune system resides.
Intestinal permeability lab: This blood test looks for antibodies against the proteins that govern your gut lining (occludin and zonulin), as well as bacterial toxins that can cause inflammation throughout the body, called lipopolysaccharides (LPS).
Multiple autoimmune reactivity labs: This array shows us if your immune system is creating antibodies against many different parts of the body, such as the brain, thyroid, gut, and adrenal glands. The labs are not meant to diagnose an autoimmune disease, but to look for possible evidence of abnormal autoimmune-inflammation activity.
Cross reactivity labs: Helpful for people who are gluten-sensitive and who have gone gluten-free and eat a clean diet, but still experience symptoms like digestive problems, fatigue, and neurological symptoms. In these cases, relatively healthy food proteins—such as gluten-free grains, eggs, dairy, chocolate, coffee, soy, and potatoes—may be mistaken by the immune system as gluten, triggering inflammation. To their immune system, it’s as if they have never gone gluten-free.
Methylation labs: Methylation is this big biochemical superhighway that makes for a healthy immune system, brain, hormones, and gut. Happening about a billion times every second in your body, if methylation isn’t working well, you aren’t either. Methylation gene mutations, such as MTHFR, are highly associated with autoimmune inflammation. For example, I have a double mutation at the MTHFR C677t gene, which means my body is not good at bringing down a source of inflammation called homocysteine. I also have autoimmune conditions on both sides of my family. By knowing my gene weaknesses, I can pay extra attention to supporting my body and lowering my risk factors as much as possible. For example, I have to be on point with eating green vegetables and sulfur-rich vegetables like cabbage and broccoli sprouts, which support healthy methylation pathways. I also have to be intentional with supplementing with activated B vitamins like methylfolate and B12 to further support my methylation.
Are there typical symptoms around autoimmunity? When do you recommend testing?
Because inflammation can impact any part of your body, the manifestations of inflammation can be far-reaching.
Some of the most common early symptoms of inflammation are:
Pain that travels throughout the body
But, look, there are many things that could cause these symptoms. In health, just because something looks and sounds like a duck doesn’t mean it’s definitively a duck. We always want to be thoughtful about symptoms and give them the due diligence they deserve.
I suggest anyone who isn’t getting better despite doing everything their doctor is telling them to do, to consider functional medicine testing; and especially anyone with a family history of autoimmunity.
“In health, just because something looks and sounds like a duck doesn’t mean it’s definitively a duck. We always want to be thoughtful about symptoms and give them the due diligence they deserve.”
Is there a protocol that you typically recommend as an autoimmune antidote?
We definitely use food as medicine. As Hippocrates, the father of medicine famously said, “let food by thy medicine, and medicine thy food.” Now, research is bearing that out. Studies estimate that about 77 percent of immune system reactions are determined by things we have at least some control over, such as our food, stress levels, and exposure to pollutants, with the remainder determined by genetics.
“Compared with the totality of human existence, the food we eat, the water we drink, the depleted soil, and polluted environment are all relatively new introductions.”
Our world has gone under a rapid change over a relatively short period of time. Compared with the totality of human existence, the food we eat, the water we drink, the depleted soil, and polluted environment are all relatively new introductions. Research is looking at this mismatch between our DNA and the world around us. Around 99 percent of our genes were formed before the development of agriculture, approximately 10,000 years ago.
With inflammatory health problems, what works for one person may not for the next. I have seen a healthy food work as wonderful food medicine for one person, and cause flare-ups in another person. I try not to have a bias and say, “This is how everyone should eat, or what everyone should do.” We have to start with a comprehensive health history, labs, then use real life as a lab. What works for someone and what doesn’t?
My job is to find out what a person’s body loves and hates. We design customized food medicine protocols, and use labs to target herbs and micronutrients to support the body based on each individual’s case.
Dealing with an autoimmune condition can be overwhelming—is there anything you’ve found that can make it less so?
The message of health responsibility is important: Knowledge is power. When you know better, you do better. This is not about shaming anyone about things they could have done differently. We all could have done our pasts differently!
But there’s much you can do in the here and now. In my experience, the vast majority of us wield so much power to take control of our health in the form of positive lifestyle health interventions—whether those changes improve our quality of life by 25 percent or 100 percent, it’s a move in the right direction. Instead of doing the same thing we always have, repeatedly, but expecting different results, we are seeing positive changes.
If all of this resonates with you, look into functional medicine further. We offer free webcam health evaluations for people around the world to get a functional medicine perspective on their case. The Institute for Functional Medicine (IFM) also has a great directory.
“In my experience, the vast majority of us wield so much power to take control of our health in the form of positive lifestyle health interventions—whether those changes improve our quality of life by 25 percent or 100 percent, it’s a move in the right direction.”
Why do you think women in particular are so vulnerable to autoimmune disease?
Sadly, 75 percent of people with autoimmune diseases are estimated to be women. Most autoimmune conditions tend to be X chromosome-linked, which is one reason why more women than men have them. Women also have more enhanced immune systems compared to men, which can make them more susceptible to autoimmune conditions. Basically, men, who have higher testosterone levels, have less active immune systems. Women have genes that make their immune system more active and this immune activity is also inversely correlated with the level of testosterone.
Another possibility is something called microchimerism. With every pregnancy, there is an exchange of cells between mom and child. Most of the time, those cells are recycled out after birth. But when that process isn’t completed correctly, those foreign cells can remain and be a constant stress to the immune system. This is one possible reason why many women can pinpoint the start of their autoimmune symptoms to post-pregnancy. Our genes and microchimerism have been the same for thousands of years—I believe it is the mismatch with the new world around us that is now awakening those latent genetic immune expressions like never before.
Dr. Will Cole, D.C., is a functional medicine practitioner with a doctorate of chiropractic from Southern California University of Health Sciences. His post doctorate training is from The Institute for Functional Medicine and Functional Medicine University. His practice is based in the Pittsburgh area, but he partners with patients—and their primary care physicians—around the world, focusing on the optimization of health for people with chronic conditions.
The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of goop, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.