Autoimmune Disorders

Paul L. Reller L.Ac. / Last Updated: August 03, 2017


Therapeutic Protocols for Autoimmune Disorders

Standard Medicine has taken a very narrow approach to the treatment of autoimmune disorders, mainly prescribing problematic synthetic corticosteroids that may eventually create health problems as serious as the autoimmune disorder itself. In recent years, a growing use of immune suppressant drugs has resulted in improved control of symptoms, but these also produce alarming adverse effects with chronic use that are usually downplayed. Finally, we are seeing a more refined combination of immune suppressing drugs and specialized biologics in recent years that can be individualized to the patient, with the lowest effective dosage prescribed to improve quality of life. By expanding this treatment protocol of autoimmune disorders with Complementary and Integrative Medicine (CIM/TCM), though, we could see further progress in reducing these problematic medications and better quality of life outcomes for millions of patients.

A comprehensive and holistic therapeutic approach seems especially important for treatment of autoimmune disorders, as evidenced by the wide range of probable systemic causes and aggravating factors. The Licensed Acupuncturist and herbalist, as well as other Complementary Medicine physicians, offer holistic and preventative medicine that is helpful in many ways in correcting and preventing autoimmune disorder of a systemic nature. Many times the patient does not perceive these therapies as dramatic, but decreasing chronic inflammatory processes, stimulating improved immune response, controlling Giardia and other unseen overgrowths and infections, improving liver health and detoxification processes, and a host of other benefits are routine aspects of care in holistic medicine. Complementary Medicine offers an array of therapies for both relief of symptoms and correction of underlying dysfunctions that cause these symptoms. Some therapies offered in TCM are dramatic, and patients with serious autoimmune disorders are sometimes amazed that they have finally found a way to improve their conditions after years of trying numerous specialists in standard medicine. Here are some of the many therapeutic protocols that have been seriously studied in recent years:

Estriol has been investigated as a symptom relieving and preventative therapeutic intervention in a number of autoimmune disorders, including rheumatoid arthritis, multiple sclerosis and autoimmune thyroiditis. A topical low dose estriol cream, properly prescribed may be beneficial to certain patients. The patient should rely on a knowledgeable physician to instruct and prescribe to insure that misuse does not lead to harmful effects or disruption of the menstrual cycle. A relative androgen deficiency and estradiol excess is often found in autoimmune disorders, and may be related to a deficiency of aromatase activity, with poor conversion of steroid hormones in peripheral tissues. DIM is a nutrient supplement that improves aromatase regulation and may help the body to correct this underlying hormonal problem. A 1992 study of patients with Lupus (SLE) noted that the aromatase activity varied inversely with the disease activity (Lupus 1992;1(3):191-5). Estriol, a less active but more abundant form of estrogen, applied locally, may alter this hormonal imbalance in peripheral tissues that drives a Th1/Th2 imbalance. Use of both DIM and estriol cream may be a useful tool in the treatment protocol.

Antioxidant therapies can protect against oxidative stress, chelate redox metals and act synergistically to create an antioxidant network to prevent overstimulation of the immune reactions to autoantigens. The most efficient enzymatic antioxidants are superoxide dismutase (SOD), catalase (Cat) and glutathione peroxidase (GSH-Px), and effective non-enzymatic antioxidants include flavonoids, alph-lipoic acid, beta-carotene, and vitamins C and E. Many supplements and herbs may improve the antioxidant metabolism, though, and thoughtful choices should be made in individual cases. The Licensed Acupuncturist has a variety of the best quality antioxidants available for use in nutriceuticals as well as herbal products. The quality of antioxidants commercially is proven to be highly suspect, and reliance on professional products is recommended. Methylselenocysteine is a potent antioxidant that has demonstrated efficacy in human clinical trials for various autoimmune disorders, including thyroiditis, Graves autoimmune and dermatomyositis. A complete, individualized and thorough treatment protocol is needed to reverse the autoimmune response, addressing the whole cycle of dsyfunction and the many underlying causes. Just blocking one of the mechanisms of the autoimmune responses may decrease symptoms, but will not be enough to achieve remission and normal homeostasis of the immune system.

Much research is being performed to identify herbal chemicals that are proven to be specific in both the treatment of autoimmune hyperreactivity as well as the modulation and regulation of the immune system. Much research points to the imbalance between two aspects of the immune T-cell system, the Th1 (T-helper cell class 1) and the Th2, in the pathology of many chronic autoimmune disorders, which allows a pro-inflammatory response to dominate the anti-inflammatory responses in immune regulation and tissue maintenance. This is a classic example of the yin and yang imbalances that Traditional Chinese Medicine see at the heart of all disease. The quality of the holistic care in the treatment of autoimmune disease completely depends on the knowledge of the prescribing physician, and the patient should choose wisely. Acupuncture research has also demonstrated positive effects concerning immune modulation (see study links below), and a combination of acupuncture and herbal medicine will work synergistically to create a more significant outcome. It is speculated that over time the chronic Th1 dominance triggers an eventual Th2 dominance that lies at the heart of most chronic autoimmune disorders. Early intervention to balance homeostatic responses and actually treat chronic inflammatory and allergic diseases, rather than just take antihistamines, NSAIDS and corticosteroids to inhibit them, and later, treatment with restorative medicine, need to be part of the standard protocol. This requires integration of Complementary Medicine (CIM/TCM) in a professional manner.

Treatment utilizing bio-identical hormone therapy could be extremely helpful in many cases, and testing and appropriate care could be the key to success in therapy. Testing with cell metabolites in saliva and veinous blood samples has progressed dramatically in recent years, giving the patients and the Complementary Medicine physicians a relatively inexpensive way to objectively analyze the individual for signs of hormonal imbalance, as well as for antibodies and other markers of autoimmune disease. Laboratory analysis in these settings often provides a more holistic individualized analysis to better guide a complete therapeutic protocol utilizing Complementary and Integrative Medicine. Not only bioidentical estriol (mentioned above), but bioidentical progesterone, pregnenelone, and various phytohormonal chemicals, are routinely used in therapy today. The use of plant lignans to stimulate enterolactones and enterodiol may also prove to be of significant benefit in many cases.

To obtain a complete discussion of the therapies available in autoimmune disorder, please call and schedule an evaluation and consult by this Complementary physician, or a Licensed Acupuncturist and herbalist, or a Naturopathic Doctor in your area. All of these physicians are well trained in medical schools and routinely provide the therapies discussed and validated by research in this article. When consulted an Integrative and Complementary Medicine physician they need not be a specialist in autoimmune disease to help you, and this field involves only general practitioners, unlike the specialization in standard medicine. This does not mean that they cannot help you treat a specific disorder.

The focus of research on specific autoimmune mechanisms is illuminating the valuable roles of Complementary Medicine in the treatment protocol

The most striking fact that one consistently sees in scientific papers describing the pathology of autoimmune diseases is that they are still poorly understood. Nevertheless, in recent years, clues to the process of autoimmunity, which is always a complex, multifactorial, and staged set of pathological dysfunctions, has yielded new understanding to critical aspects of the complex immune cascade that could produce dramatic improvement in treatment protocols, and what is needed to affect and reverse the autoimmune process. These findings are not only applied to allopathic pharmacological research, but to research into how specific herbal and nutrient chemicals, and even specific acupuncture stimulations, may affect the autoimmune pathophysiology.

Mast Cells

Mast cells are perhaps the most important immune cells studied in relation to autoimmune disfunction. For instance, increased numbers of mast cells are found in patients with systemic scleroderma, rheumatoid arthritis, and are thought to drive the disease progression. When these increased numbers of mast cells are activated, they release a variety of chemicals, some of which regulated cell growth and differentiation. Heparin released from the mast cells is a potent stimulus for growth factors that cause the problematic tissue abnormalities in these autoimmune disorders. Mast cells are considered by many experts to be basophils, a class of white blood cells, that are homed in to specific tissues and cells. Like basophils, our bodies produce these specialized immune cells from stem cell precursors in our bone marrow. Unlike basophils, mast cells do not leave our bone marrow fully matured, or developed, but are genetically programmed to mature in specialized ways when encountering chemical triggers in specific tissues in which they will reside for their lifespan. The lifespan of a mast cell may vary considerably, depending upon both the tissue specific functions it develops, and the cell environment in which it resides. For instance, a type of white blood cell, the lymphocyte, has about a 30 minute lifespan in blood circulation, but when residing in a specific tissue, this lymphocyte may survive for years. While mast cells differ from lymphocytes (B-cells, T-cells and NK cells), they stem from a common precursor, and some types of mast cells, called P-cells, or persistent cells, also have the capacity for an unusually long life span.

We may consider mast cells the body's main, or most important, immune cells. They are involved not only in allergic reactions and inflammatory responses, but relate to a wide variety of physiological and pathological processes. This diversity of differentiation, specialization, activation and the immune complement media that are produced from mast cells is strictly regulated, modulated, and controlled by our homeostatic mechanisms. The in-depth study of mast cells has helped us to better understand autoimmune processes, and also provides a valuable array of information that may guide the use of herbal and nutrient chemicals, as well as acupuncture stimulation, to correct this dysfunction of mast cell regulation and control. Acupuncture research has revealed the elaborate cascade of possible effects on modulation of immune responses. The effects of acupuncture on the nervous system, and the role of the autonomic nervous system on maintenance of immune homeostasis has brought to light the many ways that acupuncture stimulation itself may help to correct the autoimmune disorder. Of course, this type of reaction to needle stimulation, while immediate, often produces the complex desired result over time. It is not a form of magic. Symptoms are the end result of underlying physiological dysfunctions, and to truly eliminate symptoms in autoimmune disease, these underlying dysfunctions need to be corrected.

Acupuncture would work best in this regard in coordination with a comprehensive protocol, utilizing herbal and nutrient chemicals, and improvement in overall health and vitality. The cure in autoimmune disorders requires improvement in the healthy homeostatic functions of the body. Unfortunately, modern medicine limits treatment in autoimmune disorders to immune suppression to manage symptoms, and does little to even attempt to cure autoimmune disorders. Nevertheless, these immune suppressants may be needed when the autoimmune disease is threatening survival or function. The most common medication used, prednisone, or synthetic corticosteroid hormone, focus on suppressing the mast cell responses, but the wide array of effects of synthetic corticosteroids in the body make this drug problematic. The integration of Complementary Medicine and TCM allows the treating team to alleviate adverse effects of these drugs, provide support for improved physiological functions impaired by the disease mechanisms, perhaps reduce the need for high dosage of harsh drugs, and most importantly, to perhaps achieve a restoration of normal homeostatic immune mechanisms. Medical science is also now looking into markers of early stages of autoimmune dysfunction that may allow us to try to prevent the advance of these devastating disorders. Complementary Medicine provides an ideal protocol for preventive medicine in this regard.

Many types of allergic reactions activate mast cells to produce immune inflammatory or anti-inflammatory reactions. Type 1 hypersensitivity disorders activate mast cells and basophils inappropriately, and may lead to a chronic autoimmune reaction. Mast cells have specialized receptors on their membranes that allow them to interact with both B cells and T cells, as well as dendritic cells. Mast cells express the major histocompatibility complex (MHC) talked about above in this article. Mast cells also produce the cytokines (immune signaling chemicals) that regulate and control inflammatory responses. When a mast cell is activated it rapidly releases cytokines and hormonal mediators in the form of granules. A variety of triggers may stimulate this degranulation, including direct injury from trauma or chemicals, antibody cross-linking (e.g. IgE), or stimulation by immune complement proteins. The protein antibody that stimulates mast cells the most is the IgE (immunoglobulin type E), which is important to allergic response and hypersensitivity reaction. Mast cells have such a high affinity for this type of antibody that they are often covered with IgE, in irreversible bonds. As an individual acquires more and more allergic reactions and hypersensitivies to allergens and antigens, the mast cells are more affected by IgE. The abnormal expressions of these mast cells may then stimulate unwanted autoimmune responses.

When the mast cells degranulate, they may release a surprising complexity of molecules, including histamine, serotonin, heparin, protease, prostaglandin, leukotriene, thromboxane, platelet-activating factor, and various cytokines. These chemicals perform a variety of modulatory effects to stimulate either cell destruction, protection, maintenance or regrowth. The specialized mast cells exert these complex functions in our cells and tissues by interacting with the cellular and humoral environment, and the body needs to adjust, or modulate, this environment to achieve the correct mast cell response. Now, this very complex process may be impossible to regulate with man-made chemicals. Modern allopathic pharmacology is looking to affect just bits and pieces of this puzzle. Holistic medicine is seeking ways to help restore the complex evolved programming of the mast cells and their environment and triggers. This may seem like a daunting task, but research is revealing the many evolved mechanisms in nature that help our bodies achieve this task, and cure from the autoimmune disorder.

The pro-inflammatory versus anti-inflammatory role of the balance of T-helper cell types 1 and 2 (Th1/Th2)

T-helper cells are a sub-group of lymphocytes, a type of white blood cell, and provide the array of cell signaling chemicals we call cytokines, to properly regulate the array of inflammatory responses. T-helper cells are particularly important in signaling B-cells to change the production rates of the various types of antibodies. T-helper cell types 1 and 2 (Th1 and Th2) are particularly important in autoimmune pathology. Th1 provides the interferon (IFN-gamma) response, while Th2 provides the interleukin-4 and -5 (IL-4 and IL-5) that upregulate IgG4, IgA and IgE. T-helper cells activate and direct the growth of cytotoxic T cells, and maximize the activity of macrophages to destroy bacteria. When these T-helper cells are active they express the surface protein CD4, which is measured to monitor the progression of HIV. When the T-helper cell recognizes an antigen (foreign substance or toxin that generates an immune response, especially antibody production), it goes through a number of steps that may result in increased reproduction of T-helper cells, and the corresponding responses in the complex immune complement system.

Th1 will generate memory T-cell responses, as well as interferon and IL-2, within the cellular immune system, and is more partnered with the macrophages. Th2 will generate the B-cell responses with production of antibodies and memory B cells, within the humoral immune system. Each of these systems will stimulate and regulate the other, and generally, cytokines that stimulate a Th1 response will inhibit a Th2 response to provide a balanced array of cytokines to modulate inflammatory processes. Th1 will produce key cytokines associated with autoimmune processes, such as interferon-gamma (IFN-gamma) and tumor necrosis factor-beta (TNF-beta). Various interleukins are produced that stimulate specific immune or inflammatory responses during the phases of Th1 activation. Th2 will produce the interleukins IL-4, IL-5, IL-6, IL-10 and IL-13, stimulate increased B-cell activity, and antibody class switching. Normally, these two types of T-helper cell responses will maintain a safe and effective modulated immune response, so that cell and tissue destruction is not pathological. In autoimmune diseases, the Th1 to Th2 balanced responses become dysfunctional, and the search for the factors that contribute to this mis-sense has yielded a number of answers.The autoimmune reaction is essentially one of imbalance and mis-sense, most often resulting in a hyper-reactive Th2 response over time, and restoration of immune balance is essential to achieve remission. This is the focus of CIM/TCM.

Just as the role of mast cells in autoimmune pathological mechanisms presents a complicated array of potential malfunctions, the Th1/Th2 model of imbalance also is more complicated than we would like. The Th1 dominance over Th2 is seen in a variety of chronic inflammatory disorders. For instance, researchers at the Nerve-Gut Research Laboratory at the Royal Adelaide Hospital in Adelaide, Australia, found in 2009 that the Th1 dominance sensitized afferent neural responses in irritable bowel syndrome to create hypersensitivity, bowel dysfunction and pain, and an altered brain-gut response (PMID: 19566823). Over time, this chronic state of Th1 over Th2 immune imbalance could contribute to the slowly developing pathology in autoimmune disorder. Researchers at the Universidade do Grand Rio School of Medicine in Rio de Janeiro, Brazil, found in 2003 that Th1/Th2 imbalances may be the ultimate determinant factor governing the expression of IgE-mediated food allergies (PMID: 12839117). The role of mucosal and lymphoid interaction and dysfunctional immune responses concerning the Th1 dominance over the Th2 responses lies at the heart of current research into the origins of the autoimmune and hypersensitivity responses.

Complicating research into the pathology of autoimmune and hypersensitivity disorders is the finding that the stages of the disease show much different immune responses and imbalances. In many autoimmune disorders, the Th1 dominance over Th2 responses is seen in the early stages of the disease, but an eventual shift to a Th2 dominance is seen in the latter stages of the disease. This makes the reversal, or cure, of the autoimmune disorder particularly difficult, and the causes or contributors of this shift have been much studied, but are still elusive to modern science. In 1993, researchers at the UCL Medical School in London, UK, proposed a neurohormonal immune response, with peripherally activated prohormones that caused this shift in the Th1/Th2 paradigm.

Hormonal imbalances in autoimmune pathology

A number of common hormonal imbalances are linked to autoimmune disorders, often of a subclinical nature, or without clinically apparent symptoms. Hyperprolactinemia, localized androgen excess relative to localized estrogens, cortisol imbalances in a diurnal framework, and thyroid hormone dysfunctions are all important considerations in the understanding of the hormonal triggers and perpetuating factors that drive immune disorder. Poor function, or dysfunction, of the hypothalamus, thyroid and/or adrenals underlie many of these pathologies, and this is an important consideration in a holistic therapeutic protocol.

For the last decade, mild hyperprolactinemia has been considered a significant risk factor for the development of autoimmunity, especially with Rheumatoid Arthritis (RA) and Systemic Lupus Erythemematosus (SLE). Some instances of this hormonal imbalance are obvious, such as the acquiring of an autoimmune disorder postpartum, with adrenocortical deficiency, or even with aging. While hyperprolactinemia was relegated largely to suspicion of pituitary adenoma, or cancer, in the past, we now know that this hormonal imbalance is encountered at a relatively high rate in the general population. Autopsy studies have shown that hyperprolactinemia related to small pituitary lesions or microtumors occur at the rate of 5-20 percent in the population, and that the vast majority of these small tissue lesions or microtumors are benign and asymptomatic. In addition, other causes of hyperprolactinemia occur, including primary hypothyroidism, hypothalamic dysfunction or inflammation, chronic kidney failure, relative excess of estrogen (progesterone deficiency), and adverse effects from certain medications, including synthetic estrogens, dopamine inhibitors, and dopamine receptor antagonists. Dopamine inhibitors now make up a large class of medications, used to treat attention deficit and hyperactivity disorders (ADHD), obesity, depression, anxiety, Parkinson's disease, addiction, sexual dysfunction, and now added to offset the adverse effects of chronic use of antidepressant selective serotonin reuptake inhibitors. In addition, the prescription of norepinephrine and dopamine reuptake inhibitors, as well as the prescription of serotonin-norepinephrine-dopamine reuptake inhibitors, is becoming more common.

While a short while ago modern medicine considered prolactin a hormone with a narrow effect, mainly stimulating breast milk, we now know that this hormone has many effects in the body. Prolactin secretion is pulsatory and has a diurnal secretion pattern, and prolactin binds to various receptors in the liver, lymphoid cells, and gonads (testicles and ovaries). In 2011, studies showed that hyperprolactinemia was also associated with hypertension and endothelial dysfunction (arterial disease), and that diurnal fluctuations of prolactin are associated with decreased endothelial function (American Journal of Hypertension 24, May 2011: 569-573). Circulating prolactin levels also have been shown to have a positive correlation with C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR), a primary marker in autoimmune disorders. Genetic study has revealed that prolactin may have a role in initiating or sustaining inflammation in rheumatoid arthritis (association with the HLA DR4 gene), but it is unclear whether this pathogenic excess prolactin is produced by lymphocytes or has a pituitary origin. Circulating antibodies to prolactin contribute to hyperprolactinemia in SLE (Marianne J. Legato, Principles of Gender-specific Medicine).

Neurohormonal imbalances are now the focus of research concerning subclinical hyperprolactinemia. Prolactin is a stress hormone, and increased mental or physical stress has been shown to affect circulating levels. Two hormones shown to be affected significantly by emotional stress are cortisol and prolactin, with cortisol surges related to shock, surprise and an active response to stress, and prolactin surges related to humiliating experiences, rage and a passive response to stress (PMID: 14674722). Dopamine has a dominant influence over prolactin secretion, and dopamine receptor imbalance may be tied to hyperprolactinemia. Hypothalamic peptides TRH (thyrotropin-releasing hormone) and VIP (vasoactive intestinal peptide) stimulate the prolactin secretion from the pituitary, and hypothalamic dysfunction or deficiency may affect prolactin secretion, as well as various immune and inflammatory problems. When symptoms occur, anovulation, infertility, missed menstrual periods, abnormal menstrual bleeding, abnormal lactation, vaginal dryness, diminished libido, erectile dysfunction, or gynocomastia may seen, although many or most cases may be asymptomatic and subclinical. No single test can help determine the cause, or underlying etiology, of hyperprolactinemia, and a thorough and comprehensive analysis should be made by an endocrinologist. Prolactin levels in circulation vary widely in various stages of the female life span, with the changes in the menstrual cycle, and change greatly in the diurnal cycle. This is problematic, and even in cases of galactorrhea, or abnormal milk production by the breasts, circulating levels of prolactin are often normal at the time the patient is tested. Tests analyzing free prolactin in circulation in a diurnal pattern produce more definitive values.

Adrenal insufficiency syndromes are of great concern with autoimmune pathology. Adrenal glucocorticoid hormones and neurotransmitters, or steroid hormones that bind to glucocorticoid receptors, normally dampen the immune reactivity. The most potent glucocorticoid hormone is the adrenal corticosteroid, or cortisol. Cortisol imbalance within a diurnal framework, or a disorderly secretion of cortisol in the day to night cycle, is a problem for both our brain function, and the immune function. Prolactin is a stimulatory link between the neuroendocrine and immune systems, and represents a hormonal focus for the study of the obvious links between hormonal imbalance and autoimmune disorder. Thus the effects of the stress hormones cortisol and prolanctin, both released in a diurnal fashion, seem most important in assessing neurohormonal balance and autoimmune disorder. We see that cortisol is produced mainly by the adrenal glands and prolactin mainly by the pituitary, representing both ends of the adrenal-pituitary axis. Addressing issues of adrenal insufficiency and adrenal stress syndrome has thus been a major issue in the treatment of autoimmune disease in the last decade.

Dr. John Lee, the pioneer of study of the bioidentical hormone therapies so much in use today, wrote extensively on the connection between hormonal imbalance and autoimmune disorder. Dr. Lee wrote: "Autoimmune disorders in general are thought to be triggered by transient viruses in susceptible people; the virus triggers antibodies against some protein component of the virus (the capsule). By some probably minor fluke, the antibodies attack similar proteins in certain body tissues...Corticosteroids block this attack by one's own antibodies. One can hypothesize that estrogen dominance (relative progesterone deficiency) may have had a hand in triggering the errant antibodies, and thus correcting the estrogen dominance leads to a gradual correction of the problem. Progesterone is also the main precursor of corticosteroids and in progesterone-deficient women, restoration of the normal progesterone levels may enhance normal corticosteroid production, thus suppressing the autoimmune attack." In Dr. Lee's clinical practice, he observed the positive effects of correction of progesterone deficiency with bioidentical hormone creams and nutrient medicines in the treatment of autoimmune disorders.

In 2008, researchers at the National Institute of Mental Health, National Institutes of Health, in Rockville, Maryland, published an explanation of how glucocorticoids, such as cortisol, and progestins, such as progesterone, play a central role in the pathology of autoimmune disease (see study link below). These researchers stated that dysregulation of cortisol and progesterone may contribute to autoimmune and inflammatory disesases by failing to modulate inflammatory events within the feedback cycle between the adrenal-pituitary axis, the autonomic nervous system, and the central nervous system and the immune cytokine responses. They stated that recent studies have shown the important role of progesterone as an immune regulator, adding to the knowledge of the significant roles that cortisol, androgens, and estrogens play in the immunomodulatory cycle. In other words, Dr. John Lee appears to have been correct. Complementary Medicine, with its focus on the holistic aspects of this autoimmune pathology, also appears to have been spot on. In such a feedback cycle, involving the immune system, the CNS, and the endocrine axis, treatment has to be holistic, complex and individualized to restore homeostasis and cure the autoimmune dysfunction.

These NIH researchers stated: "Glucocorticoids play a crucial role in the immune response, from initial activation to eventual suppression and restoration of homeostasis. Emerging evidence indicates that progesterone also plays an important role outside of the context of pregnancy. When the actions of these hormones are impaired at the level of their receptors through changes of isoform expression or genetic mutations, the resulting dysregulation of the immune response many enhance susceptibility to development of infectious or inflammatory disease. As a result of the complexity of neuroendocrine-immune interactions, no single event that changes glucocorticoid receptor or progesterone receptor activity is likely to be responsible for the development of disease, but these host factors together can contribute to disease progression." (Journal of Leukocyte Biology 2008;84:924-931).