Find out what the challenges are with dealing with the multiple facets of autoimmunity, looking at it from different perspectives.

1. Managing Autoimmunity
Nancy Doreo
Teaching and Learning Strategies
Dr. Heather Zwickey
NUNM, Spring 2017

2. Autoimmunity Origins
Horror autotoxicus:
Literally, the horror of
self-toxicity.
A term coined by the
German immunologist
Paul Ehrlich (1854-1915)
to describe the body's
innate aversion to
immunological self-
destruction.

3. History Continued
This concept of autoimmunity as the cause of
human illness is relatively new, and it was not
accepted into the mainstream of medical
thinking until the 1950s and 1960s.

4. Prevalence
• Autoimmune diseases are a major threat to
the health of all Americans.
• 14 to 27 million Americans suffer from the
more than eighty illnesses caused by
autoimmunity.
• The incidence is on the rise.

5. 2 Most Common Symptoms
•PAIN
•FATIGUE

6. Causes of Autoimmunity

8. AutoImmunity Reality:
• Fix?
• Manages
• Fluctuates
Viruses/Epstein Barr
Measles/EBV
Antibiotics/infection
Stress/Smoking/Infection
Chemical exposure/Infection

9. Environment
• Pathogens, drugs, hormones, and toxins are
just a few ways that the environment can
trigger autoimmunity

10. Environmental Triggers
• LOCATION
• STRESSES
• DIET (gmo,
processed)
• PAST HISTORY
• NEURO-ENDOCRINE
• MEDICAL THERAPIES

11. Integrity of Barriers
• Lungs
• Skin
• Gut

12. SMBTCWOLGS01(013111)DATI
S.PPT
Copyright © 2011, Datis
12By permission of Dr. Aristo Vojdani, Ph. D., M. Sc., C. L. S.

13. SMBTCWOLGS01(013111)DATIS.PPT
Copyright © 2011, Datis Kharrazian. All Rights Reserved
13
By permission of Dr. Aristo Vojdani, Ph. D., M. Sc., C. L. S.
Assess for Intestinal Permeability
• suspect
• treat
• protect

14. SMBTCWOLGS01(013111)DATI
S.PPT
Copyright © 2011, Datis
14
Gluten-Associated Sensitivity
and Cross-Reactive Foods
Panel 4, serum IgG and IgA
a-Casein Sorghum
b-Casein Millet
Casomorphin Tapioca
Milk Butyrophilin Amaranth
Cow’s Milk Quinoa
American Cheese Yeast
Chocolate Spelt
Coffee Polish Wheat
Rye Sesame
Barley Corn
Oats Rice
Buckwheat Potato

15. Inflammatory Cytokines
• Inhibit red blood cell growth
• Activate Microglia
• Cause pain
• Cause stiffness
• Impair intestinal barrier
• Impair blood brain barrier
• Wreak chemical havoc with neurotransmitters,
hormones, nitric oxide, glutathione

16. Some conditions with known inflammatory components
• Metabolic syndrome, diabetes
• Heart disease
• Inflammatory bowel disease
• Celiac
• Autoimmune diseases
• Cancer
• “itises” (arthritis, etc.)
• HIV
• MS
• Osteoporosis
• Chronic infections (e.g.,
recurrent sinusitis, Lyme or
tick-borne diseases,
periodontal disease,
infected root canals,
bacterial overgrowth of the
small intestine, GI infections,
candidiasis…)

17. Gut
• List 3 reasons why it is an effective first step to
evaluate the gut barrier in managing
autoimmunity.

18. Genomics
• Glutathione Peroxidase 1 SNP
• Metalloproteinase SNPs
• 5 MTHFR
• Others…
Genova

19. Detoxification Pathways
• Liver Phase 1
– the cytochrome P450s require several nutrients to function, such
as copper, magnesium, zinc and vitamin C
• Liver Phase 2
– · Glutathione conjugation:
Methionine/Cysteine/Glutamate
– · Amino acid conjugation:
cysteine/taurine/glycine/glutamine
– · Methylation: Folate, B12, Choline, Methionine
– · Sulfation: sulfur foods, glutathione, taurine
– · Acetylation: thiamine, pantothenic acid, and vitamin C
– · Glucuronidation: Magnesium

20. Systems Permit Viscous Cycles
• Mercury Poisons Methionine Synthase
• Default in GSH and GSSG permit poor
detoxification of haptens
Inflammation is BiDirectional
Brain BBB Periphery
Cytokines reduce memory and increase anxiety

21. Systems Permit Viscous Cycles
• Mercury Poisons Methionine Synthase
• Default in GSH and GSSG permit poor
detoxification of haptens
• Virtually every major organ system
21

22. Modifying Processes Rather than Curing Diseases
environmental factors + susceptibility
GSH + 4R Program + Anti-Inflammatory Lifestyle
Chapter 23, Textbook of Functional Medicine, page 319
Low GSH + Low Vit D + Stress = illness
Low GSH + Toxic Metal Exposure = illness
Low GSH + Gluten Intolerance= illness
22
Let’s Do Some Math:

23. Genetic Predisposition

24. GPx1 Polymorphisms
GPx-1 polymorphism (rs1050450) contributes to tumor susceptibility
J Cancer Res Clin Oncol. 2011 Oct;137(10):1553-61
prostate cancer , breast cancer, ovarian cancer and lung cancer may be
modulated by GPX1 polymorphism and that the combination of genetic
factors involved in oxidative response with environmental carcinogens may
play an important role in carcinogenesis.
Genetic Predisposition
Glutathione helps defend the body against damage from cigarette smoking,
exposure to radiation, cancer chemotherapy, and toxins such as alcohol. As a
detoxifier of heavy metals and drugs; it aids in the treatment of depression,
schizophrenia, bipolar and chronic fatigue, blood, immune and liver disorders
24

25. Some conditions with known glutathione deficiency
• Heart disease
• Neurodegenerative
– ALS, MS, AD, PD
• Autoimmune diseases
– Thyroid, AIDS
• Cancer
• Brain
– Schizophrenia, Bipolar
– ADHD, Autism
– TBI
• Drug Damage
• Alcohol
• Smokers
• Low Immune
― WBCs low
25

26. Critical Management Points
• History
• Exam
• Labs: in office challenges, blood/saliva/urine
• Working Diagnosis versus Existing Diagnosis
• Plan of Action
– Phases of Plan
– Follow Up
– Re-evaluate

27. RA
Inflammatory prostaglandins lead to upregulated Th1
SLE
Disease of upregulated Th2
Variable in response to pregnancy
High Estrogen increases Th2 activity- worsens condition
Low Estrogen at menopause usually symptoms improve
Thyroid Interactions
Thyroid gland reactively attempts to balance the
effects of elevated adrenalin, feedback attempts to
lower T4 to counteract cardiac irritability, leads to
elevations of TSH with symptoms of hypothyroidism.
Some Examples of Imbalances

28. Know Your Effects
TH1 Stimulators
Astragalus
Echinacea
Mushrooms
Goldenseal
TH2 Stimulators
Green tea
Grape seed
Pine bark
Lycopene
Regulatory T Cells
Vitamin D
EPA DHA
Glutathione
SOD
Anti-inflammatory
Boswellia
Curcumin
Quercitin
Dr. Datis Kharrazian, DC, DIBAK, DABCN, etc… Mastering the Thyroid

29. DISCUSSION
• What might you recommend as natural
interventions for inflammation?
• If a person needs to support the TH2 system,
would Echinacea be a good choice?? Why or
Why Not?

30. Summary of therapies for the
immune system
• Folic Acid
• Vitamin B12
Support IL 10
• Pycnogenol
• Green Tea
• Resveratrol
• Hespiridin
• Vitamin A
• Probiotics
Support T Reg
Vitamin D
Glutathione
SOD
Cordyceps
PG E1
BCSO, EPO, Borage
PG E2
Avoid NSAIDs
Dr. Walter Schmitt, DC DIBAK DABCN , The Immune System, What to Do First, Next and Last

31. TH1 / TH2 Challenge,
the Teeter-Totter of imbalance
– Record symptoms for worsening/improvement
– When not to challenge
– When to stop the challenge
What to do with the results…

32. Modulation of autoimmune diseases by nitric oxide.
Singh VK, Mehrotra S, Narayan P, Pandey CM, Agarwal SS.
Immunol Res. 2000;22(1):1-19.
Nitric oxide (NO) is an intercellular messenger that performs a
number of functions, including neurotransmission,
vasodilatation, inhibition of platelet aggregation, and
modulation of leukocyte adhesion. NO has recently been shown
to act as a potent cytotoxic effector molecule as well as to play
an important role in the pathogenesis of organ-specific
autoimmunity. NO may also modulate the immune response by
interfering with Th1/Th2 balance in autoimmune diseases.
This review will discuss the role of NO and nitric oxide synthase
(NOS) in pathophysiologic and therapeutic implications in various
autoimmune diseases with particular reference to T helper-1
(Th1) and T helper-2 (Th2) cytokines.

33. AutoImmunity Reality:
• Fix?
• Manages
• Fluctuates

34. Get the BIG Idea
• Management
• Teach Management Strategies

35. Systemic Structural Factors
• Spinal
• Cranial
• Pain Referral Patterns
• Hemisphericity
– Left Brain / Right Brain Dominance

36. Left Brain/Right Brain Immune
• The left brain activates the immune system in
such a way that it produces a barrage of
protection against outside threats, and if
uninhibited by the right brain, against our own
tissues.
• The right hemisphere gives us empathy toward
others. It is the hemisphere that feels our organs
and tissues and regulates their drive – keeping
digestion under control, keeping the immune
system regulated so it doesn’t attack our own
tissues and keeping our heart beat regular

37. Sydney MacDonald Baker, MD 2006
“He who ignores
individuality fails the
patient.”

38. Dr. Chris Astill-Smith, DO, DIBAK
Top 3
• Magnesium
• B6, Pyridoxal 5 Phosphate
• Zinc

39. Dr. Mark Hyman, MD
Author
https://www.youtube.com/watch?v=Eh2PYQBICWs
Glutathione: The "mother" of all antioxidants...

40. Modifying Processes Rather than Curing Diseases
environmental factors + susceptibility
4R Program + Anti-Inflammatory Lifestyle
Chapter 23, Textbook of Functional Medicine, page 319

41. So, what are you going to do?
Test with Labs
Gut Barrier
Glutathione Stores
Anti-Inflammatory Lifestyle
Exercise and Rest Habits
Treatment and Follow Up
Basics that will diagnose, heal and protect:

42. Study, know where to look things up
Work with other specialists
Continue learning from mentors
Be willing to change and grow
Take care of yourself
Help a lot of people
The business of Doctoring is Dynamic!