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Autoimmunity: the Fatigue Factor.


Today I want to shine a light on autoimmunity. Autoimmunity can be very illusive. It often goes undiagnosed for years because the symptoms seem “random” or mimic other health issues and get misdiagnosed, until they become extreme and warrant a deeper look.

I hope to raise awareness about some of the most common autoimmune conditions, the symptoms that are present and if there is testing available so if you have symptoms, you can ask your provider for help.

We've been highlighting the symptoms of fatigue and associated causes over the past several weeks, and while fatigue alone isn't enough to diagnose autoimmunity, you can ask anybody suffering with a diagnosed autoimmune condition and fatigue will likely be at the top of their symptom list.

The Background Info

Autoimmune conditions represent about 4% of the worlds' population, or about 10 Million people. But the American Autoimmune Related Diseases Association estimates that 50 Million people are likely experiencing life with autoimmunity. The number has continued to rise over the years, for unknown reasons (although from a functional medicine perspective, there are some possible explanations), and women are 3 times more likely than men to have an autoimmune condition (78% of all people diagnosed with autoimmunity in the US are women).

The immune system is meant to protect us from foreign invaders (think Covid-19 or Influenza), but in the case of autoimmunity, antibodies are produced by the immune system that are attacking “self”. There can be autoimmunity causing damage to a specific organ such as Hashimotos or Graves Disease (thyroid), Celiac Disease (small bowel) or Ulcerative Colitis (large bowel). There are systemic autoimmune conditions that can cause damage throughout the body such as Systemic Lupus and Rheumatoid Arthritis.

Autoimmunity is genetic, so if there are any known autoimmune conditions in your family history, be aware that this alone increases your risk of developing an autoimmune condition. But just because there is autoimmunity in the family genetics does not mean you will develop an autoimmune condition - just something to have on your list of things to rule out if you have symptoms.

We do have a level of control over autoimmune disease prevention and remission. Genetics, inflammatory triggers and poor gut health are 3 pillars of autoimmunity and while we can't do anything to change the genetics we've been given, we can do our best to reduce inflammation and optimize gut health.

There are over 100 autoimmune diseases, let's cover some of the most common ones now.

**Common symptoms of all autoimmune conditions include fatigue and brain fog. (Making that known here so I don't repeat it below).

Hashimotos/Graves Disease

The immune system creates antibodies that attack the thyroid gland, causing damage and an imbalance in thyroid hormone production.

  • Symptoms: Hashimotos: Constipation, cold intolerance, dry skin, brittle nails, hair thinning on head and eyebrows, weight gain, joint pain. Graves: diarrhea, heat intolerance, heart palpitations, hair thinning, weight loss, feeling anxious/jittery, trouble sleeping.

  • Diagnosis: Labs: specific for the autoimmunity is having thyroid antibody levels drawn - Thyroid Peroxidase (TPO) and Anti-Thyroglobulin Antibodies. TPO being elevated is specific for thyroid autoimmunity but Anti-thyroglobulin antibodies alone being elevated should be confirmed with a thyroid ultrasound. Thyroid Ultrasound: A thyroid ultrasound alone can be a diagnosis of thyroid autoimmunity because it shows changes to the thyroid tissue due to the immune attack. Without drawing labs to evaluate the thyroid antibodies though, it wouldn't be known if the autoimmunity is a current flare or in remission. (antibodies can be lowered so the attack on the thyroid stops).

Poly Cystic Ovary Syndrome (PCOS)

“In PCOS a low level of progesterone overstimulates the immune system that leads to production of autoantibodies and therefore it can be labeled as an autoimmune disorder” (1)

  • Symptoms: Irregular menstruation (can miss period for several months at a time), facial/neck dark hair growth, acne, hair thinning through top of scalp, ovarian cysts, weight gain/difficulty losing weight, infertility.

  • Diagnosis: Having at least 2 of the following 3 symptoms: Polycystic ovaries (confirmed via Ultra Sound), Elevated Androgens (labs: Total and free Testosterone, DHEA), Oligomenorrhea (fewer than 8 periods a year).

Celiac Disease

Consuming the gluten protein triggers the immune system to produce autoantibodies that attack the small intestine.

  • Symptoms: digestive symptoms - bloating, constipation/diarrhea, nausea abdominal pain. Headache/migraine, joint pain, anemia, skin rash.

  • Diagnosis: Gluten must be consumed within several weeks leading up to the testing (other than the genetic test) to be an accurate result. Labs: tissue transglutaminase (tTG) immunoglobulin A (IgA) and tTG immunoglobulin G (IgG) tests, endomysial antibody (EMA) -IgA test, deamidated gliadin peptide (DGP) -IgA and DGP-IgG tests. If these lab results come back positive, an upper GI endoscopy with a biopsy of the duodenum should be done to confirm the diagnosis of Celiac disease.

  • There is also a genetic test that can be done where about 95% of people with celiac disease have HLA-DQ2.5. Among the other 5%, most have HLA-DQ8. Being positive for these genes does not mean you have celiac disease, but if the genetics come back negative then you likely won't develop Celiac disease.

Crohn's and Ulcerative Colitis

A extreme inflammatory disease of the bowel and can be life threatening when undiagnosed and untreated. (known as Inflammatory Bowel Disease).

  • Symptoms: Diarrhea, blood and/or mucous in the stool, abdominal pain/cramping, mouth sores, iron anemia, low appetite/nausea, fever.

  • Diagnosis: Through a colonoscopy of the bowel (endoscopy may be ordered because Crohn's can affect the upper GI tract as well). Can also be indicated through a stool test of Calprotectin being elevated which is an inflammation marker. If this is elevated then a Colonoscopy should be done to evaluate for Crohn's Disease or Ulcerative Colitis.

Lupus

Antibodies are created by the immune system that cause damage and inflammation throughout body including joints, skin, kidneys, blood cells, brain, heart and lungs.

  • Symptoms: Fever, Joint pain/stiffness/swelling, Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose or rashes elsewhere on the body, Skin lesions that appear or worsen with sun exposure, Headaches, confusion and memory loss.

  • Diagnosis: No single test will diagnose Lupus but can be a compilation of symptoms, physical exam and a blood test for the antinuclear antibody (ANA). A positive ANA does not necessarily mean you have lupus. A Skin or kidney biopsy may also be performed for diagnosis.

Multiple Sclerosis (MS)

An inflammatory disease that damages the nerves of the brain, spinal cord and optic nerves, which make up the central nervous system.

  • Symptoms: Headaches, heat intolerance, vertigo, visual problems, numbness/tingling/weakness of the mouth or extremities, constipation.

  • Diagnosis: There is no specific test for MS, but an MRI of the brain and spinal cord and/or a spinal tap along with symptoms and physical exam will be used in making a diagnosis.

Wrap Up

The symptoms listed above are not all inclusive, and you don't have to have every symptom to have the autoimmune condition. If you suspect you may have autoimmunity, please seek help from your provider.


Your friend in health,


Alyssa Vest FNP


P.S. If you'd like to receive more information like this, make sure to subscribe for my weekly email.

Resources:

  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871972/#:~:text=In%20PCOS%20low%20level%20of,an%20autoimmune%20disorder%20%5B61%5D. (1)

  • https://my.clevelandclinic.org/health/diseases/21624-autoimmune-diseases

  • https://www.aafp.org/pubs/afp/issues/2016/0715/p106.html

  • https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/digestive-diseases/celiac-disease-health-care-professionals

  • https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304#:~:text=Crohn's%20disease%20is%20a%20type,fatigue%2C%20weight%20loss%20and%20malnutrition.

  • https://www.mayoclinic.org/diseases-conditions/lupus/symptoms-causes/syc-20365789#:~:text=Lupus%20is%20a%20disease%20that,%2C%20brain%2C%20heart%20and%20lungs.

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