Treating Autoimmune Disease using naturopathic principles

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Treating Autoimmune Disease Using Naturopathic Principles

By Axelrod, ND, L.Ac.

Sep 29, 2005

http://www.scnm.edu/news/article_665.php

Printed with permission from Naturopathic Doctor News & Review,

September 2005 Issue

Five years ago, I was offered the opportunity to work in a

Rheumatology practice. When asked to join, my initial thought was

this is a very difficult population and I don't feel very competent

treating autoimmune disease. Besides, I don't have a " cure. " Five

years later, I have come to some different realizations. I still

don't have a " cure, " but I can significantly improve the quality of

life of patients with autoimmune disease by applying basic

naturopathic principles. This article will discuss why adrenal

hormones, digestion, and diet must be addressed. Specific

therapeutic strategies will be discussed.

It is not uncommon to find a history of high levels of stress,

environmental exposures or other issues that may have preceded

chronic illness. Patients may have been able to tolerate them, until

a major stressor occurred which put them into a state of chronic

disease. A common finding in patients with autoimmune disease is an

abnormal cortisol response.

Multiple studies have shown a dysregulation of cortisol response to

various stressors, including cytokines, surgery, exercise and

circadian rhythms. Interleukin-6 (IL-6), a pro-inflammatory cytokine

which is elevated in rheumatoid arthritis (RA), has diurnal

variations. It was found that RA patients did not have the expected

increase in cortisol, which is necessary to inhibit the inflammatory

response. In addition, autoimmune patients tend to have a blunted

response to cortisol in peripheral tissues and with surgery. A

significant reduction in cortisol levels at peak and post exercise

compared to controls was found in RA and systemic lupus

erythematosus (SLE) patients. It has also been demonstrated that

patients with low to moderate RA disease activity tend to have lower

cortisol levels and abnormal circadian rhythms, while patients with

more severe disease activity have more elevated levels with loss of

circadian rhythms. Higher levels of serum cortisol have been shown

to increase the erythrocyte sedimentation rate (ESR). ESR is most

commonly used to monitor the level of inflammation with autoimmune

patients, due to the cost and ease of performance. Adrenal function

testing can also give valuable information, especially when

performed with multiple samples displaying the circadian rhythm.

DHEA has been shown to be decreased in RA and SLE patients. In a 24

week study of adult Chinese women with mild to moderate SLE,

treatment with DHEA 200mg once daily resulted in significant

reduction of serum levels of Interleukin-10. IL-10 has been

associated with increased disease activity in SLE, proteinuria and

Anti-ds-DNA elevation. This finding may suggest why DHEA could

significantly reduce lupus flares. During DHEA supplementation,

serum androstenedione and testosterone increased, while there were

no changes in serum estradiol or estrone. This pharmacologic dosing

of DHEA for SLE is becoming more common practice among

rheumatologists. It has also been recommended to supplement DHEA for

patients on corticosteroids to decrease the catabolic effect of the

steroids.

Naturopathic principles frequently point to digestion as an

underlying cause of disease. Autoimmune patients very commonly have

gastrointestinal issues associated with the disease process.

Sjögren's patients may have pancreatic enzyme deficiency associated

with lymphocytic infiltration of the pancreas. Scleroderma patients

have a higher incidence of GERD and hypochlorhydria. Dysbiosis is

commonly found with an increased frequency of organisms including

Klebsiella pneumoniae in ankylosing spondylitis (AS) and Proteus

mirabilis in RA. Elevated IgG levels and increased serum IgA against

Klebsiella was found in AS patients, but with a coexisting reduction

in K. pneumoniae responsive T cells. This indicates a defective

response to the organism. A high frequency of small intestinal

bacterial overgrowth has been found in patients with RA and has been

associated with a high disease score. The bacterial overgrowth was

seen in patients with normal hydrochloric acid production and

hypochlorhydia.

Lactobacillus has been found to decrease the disease activity of RA.

Ingestion of a commercial yogurt containing lactobacilli, especially

Lactobacillus GG, was found to result in a much milder form of

autoimmune induced arthritis than the control group in a rat study.

Ingestion of live or heat-killed human LGG had a clinically

beneficial effect on rats with experimentally induced arthritis.

It is also interesting to note the relationship between certain

gastrointestinal infections caused by organisms such as Salmonella

and Shigella with the induction of HLA-B27, resulting in the

commencement of autoimmune diseases such as ankylosing spondylitis,

rheumatoid arthritis, lupus and psoriatic arthritis. This is not an

uncommon finding in these patients with a genetic predisposition.

Other organisms including, but not limited to Chlamydia,

streptococcal infections and amoebas have also been implicated in

inducing autoimmune diseases. It is valuable to perform a

comprehensive stool analysis with a parasitology times three in your

patients. Treat the dysbiosis as well as IgA deficiencies or

defects.

As with any disease, treatment varies depending on the individual.

Multiple studies have been performed to evaluate the effect of

fasting, vegetarian and elimination diets on rheumatological

diseases. A questionnaire based survey showed that 37-43% of

patients with rheumatic diseases had increased symptoms associated

with specific foods. Fasting commonly reduces symptoms

significantly, with a relapse following re-introduction. In one

study, rheumatoid arthritis patients followed a vegetarian diet for

two years. Reduction of objective and subjective disease was

statistically significant, including ESR. Upon re-introduction of

foods, it was found that meat, coffee and refined sugar products

were found to be the most common offenders. In another study, RA

patients were found to have elevated IgG, IgA and IgM antibodies to

specific foods, especially lactalbumin, compared to healthy

subjects. Gluten-free diets have been beneficial to patients,

especially when combined with vegetarian diets, decreasing C-

Reactive Protein (CRP) and symptoms. Many studies found a

correlation with inflammatory markers and symptom relief, however

this was not universal. Subjective reporting is important, but does

not guarantee the absence of joint destruction. Physical exam and

diagnostic testing, including ESR (especially in RA patients) should

be performed regularly.

Since I work in an office with rheumatologists, my patient

population tends to present on multiple medications. For this

reason, I usually don't completely fast my patients. Also, if the

patient is on immunosuppressants, allergy testing may yield false

negatives. My typical elimination diet includes: non-starchy steamed

vegetables (carrots okay), primarily with rice for three days. Only

steamed vegetables and fresh vegetable juices for three days, and

then repeat the steamed vegetables and rice for the last three days.

The patient supplements with a fortified protein powder with

components that heal the gut lining. In some cases if the patient is

unable to follow through, I will allow a white fish to supplement.

The majority of patients either have a significant reduction of

symptoms or are symptom-free while on this diet. In some patients, I

have seen sedimentation rates drop significantly, along with pain

and stiffness, which makes it useful during a flare of a disease.

The challenge is the re-introduction and food intolerance discovery.

Frequently symptoms return during this time, which is an incentive

for the patient to follow a strict dietary regimen, while rebuilding

the gut. In some patients where the elimination diet is not an

option, a diet according to blood type may be effective.

Fibrinolytic enzymes can be also helpful to reduce the level of

inflammation. It is important to remember that if there is active

inflammation and swelling of joints in conditions such as RA,

reactive arthritis (formerly Reiter's) and psoriatic arthritis,

there is most likely joint destruction occurring. Lupus patients

tend to have a less erosive arthritis. The enzymes may be used as

maintenance or symptomatically for a flare of symptoms. A

sarcoidosis patient reduced her methotrexate and began to have

arthralgias, fatigue and eye discomfort. She had a history of

recurrent iritis. Wobenzym® was given at a dose of ten tablets tid

daily between meals. She was able to maintain this lower dose

without incident.

In general, immune modulating therapies are used, such as fish oils

and plant sterols. Glycyrrhiza can be very helpful for adrenal

function and weaning patients off steroids. There is much

controversy about the use of immune stimulating botanicals such as

Echinacea in autoimmune patients. Our experience is that most

autoimmune patients can tolerate immune stimulating botanicals,

except for lupus patients. Lupus patients are highly reactive with

flares that may be severe and should be treated with caution.

Treating patients with autoimmune disease can be very challenging.

Applying Naturopathic principles should always be the basis of

treatment. I teach Rheumatology at Southwest College of Naturopathic

Medicine, and I once had one of my Rheumatology colleagues teach a

class in my absence. A student asked, " What type of response do

patients have to naturopathic medicine when they see Dr. Axelrod? "

My colleague's response was that every patient she refers for

naturopathic care improves. However, I still can't say I have

the " cure " for all my autoimmune patients, but I can say that

Naturopathic medicine is a powerful tool and you can and will

significantly change the quality of life and the course of disease

in many autoimmune patients in your practice.

ABOUT DR. AXELROD

Dr. Axelrod holds a B.S. in Nutrition from the University of

Massachusetts and an N.D. from Bastyr University (1987). She is also

a graduate (1999) of Southwest College's Acupuncture program and is

nationally certified and state licensed in Acupuncture. She attended

the New England School of Homeopathy. She offers medical services

including family medicine, women's health and rheumatology,

acupuncture, homeopathy, pain management, nutrition and botanical

medicine. Dr. Axelrod is a Professor of Clinical Sciences at SCNM

and is on the staff at Maricopa Integrative Health System as a

Naturopathic Physician.

ABOUT NDNR

Naturopathic Doctor News & Review is the only professional news and

information resource published exclusively for naturopathic

physicians in North America. ND News & Review serves as a dynamic

voice for the advancement of naturopathic medicine while promoting

personal and professional development for practicing naturopathic

physicians.

ND News & Review is a forum in which naturopathic physicians share

information about practice management, business development,

marketing, networking, clinical research and other important issues

in the field today.

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