Integrative and Holistic Factors that Contribute to Autoimmune Disease

Autoimmune diseases are those that develop in conditions where the body’s cells are unable to distinguish between pathogenic cells and its own cells. The result: The immune system destroys its own cells. 

There are over 100 known autoimmune diseases, and autoimmunity is on the rise in America. 

As a holistic health coach, you will likely engage with clients who are living with or at risk of autoimmune disease. While your responsibility as a coach is not to diagnose or treat autoimmune diseases, you can assist your clients by supporting them in implementing health behaviors that can help to:

• Identify factors contributing to autoimmune disease risk
• Prevent autoimmune disease
• Manage autoimmune disease symptoms 

In this article, we summarize the integrative and holistic factors that contribute to autoimmune disease. More specifically, we describe how a wide variety of lifestyle, genetic, social, and environmental factors may increase the risk of developing autoimmune disease. 

What Is Autoimmunity? 

Under normal circumstances, the immune system is capable of determining which cells in the body are foreign and which are it’s own. When the immune system mistakes the cells of its host’s body as foreign and dangerous, it can begin to attack itself. This is the process of autoimmunity, which results in autoimmune disease. 

In more technical, biomedical terms, Johns Hopkins Medicine defines “autoimmunity [as] the presence of antibodies (which are made by B lymphocytes) and T lymphocytes directed against normal components of a person (autoantigens). These components are called autoantigens or self-antigens and typically consist of proteins (or proteins complexed to nucleic acids).”

It is important to note that popular discourse around autoimmune disease comes from a Western biomedical perspective. Most diagnostic, treatment and management resources in the United States are based on this perspective. However, there are several traditional medicine systems and theories that may understand and approach autoimmune diseases differently. These include, but are not limited to:

• Ayurveda
• Traditional Chinese medicine
• Unani
• Kampo (traditional Japanese medicine)
• Traditional Korean medicine (TKM)
• Sasang constitutional medicine (SCM)
• Traditional Aboriginal medicine
• Traditional medicine in Africa
• Russian herbal medicine

When speaking to clients, you may want to ask them if there are traditional medicine systems and theories that make more sense of their view and experience of wellness. 

A Holistic, Wellness Approach to Autoimmunity and Autoimmune Disease

On one end of the health-disease spectrum is optimal health, which leads to high-level functioning. On the opposite end of the health-disease spectrum is disability limitation, which leads to premature death. 

A biomedical approach, the approach on which the US healthcare system is based, is a disease treatment-based perspective. Diseases are perceived as the result of the negative effects on the body of a diagnosable condition.

In other words, in a biomedical approach, most interventions take place in individuals on the part of the spectrum where diseases are developing, symptomatic, and, eventually, become debilitating and lead to an increased risk of mortality. 

A wellness approach to autoimmunity takes a much wider, multifactorial perspective to understand, prevent, and manage health and disease in two primary ways. 

First, the wellness perspective focuses on all dimensions of health, not just physical health. The seven dimensions of health include: 

• Intellectual health
• Physical health 
• Social health 
• Emotional health 
• Spiritual health 
• Occupational health
• Environmental health (in some models, this is replaced by cultural health, considering that environmental health is integrated into the previous dimensions of health)

In the biomedical perspective of health, diagnosis and treatment approaches focus primarily on the measurable physical signs of health and disease. 

The second element that sets the wellness approach to health apart from the biomedical approach is that, in addition to recognizing, preventing, and managing asymptomatic and symptomatic disease, disability limitation, and preventing premature death, the wellness approach also considers growth and development, a continual quest for vitality, and optimal health as essential for high-level functioning and true wellbeing.

The wellness approach recognizes that high-level functioning and a sense of fulfillment are only possible when all dimensions of health are valued and tended to. Many of the same approaches are implemented whether a person is healthy or not. 

The graphic below helps to describe the differences in the health and wellness and biomedical approach. 

6 Integrative and Holistic Factors that Increase the Risk of Autoimmune Disease 

Xenobiotic Exposure 

Xenobiotics are foreign chemical substances that are not naturally produced by or present in the organism. They are present in the environment around us, including in the foods we eat, the liquids we drink, the air we breathe, the home goods we use, and the personal care and cleaning products we use. 

Most xenobiotics are not harmful in the amounts to which we are exposed to them, but since it is generally understood autoimmune disease development is associated with xenobiotic exposure to some extent, there has been an effort to discover which xenobiotic components and at what levels does exposure pose a risk. 

Researchers have found several specific xenobiotics that are linked to illness and an increased risk of developing chronic and autoimmune diseases when humans are exposed to them beyond levels our immune systems can effectively neutralize and excrete. Some of these xenobiotics include: 

• BPA
• Phthalates
• Triclosan
• Parabens
• Herbicides
• Pesticides
• Phenols
• Heavy metals
• Mold and mycotoxins

Source: Adapted from: https://linkinghub.elsevier.com/retrieve/pii/B9780128164839000062 

Research is still underway to understand how specific xenobiotics affect the risk of certain autoimmune diseases. 

Stress and Lifestyle

Lifestyle factors including health behaviors and exposure to stressful environments have a direct impact on the risk of developing autoimmune diseases. 

Some of the health behaviors associated with an increased risk of disease, including autoimmune disease, include: 

• Smoking
• Lack of sleep
• Physical inactivity (sedentarism)
• Drugs
• If and how often an individual is screened for disease
• Excessive sun exposure
• Alcohol consumption
• A diet that does not meet or exceeds nutrient needs

Another vital yet complex factor that influences the risk of developing autoimmune diseases is the level and longevity of stress in people’s lives. 

The stress response is exactly what it sounds like; it is the way your body reacts to a stressor, which might be a threat, a deadline, uncertainty, or endless others. 

Cortisol, commonly known as the “stress hormone,” will keep your body alert and revved up. When the perceived threat is no longer present, cortisol levels fall, and the parasympathetic nervous system activates “the brake,” which dampens stress response. 

In light to moderate levels, stress is a vital part of life; it helps us to adapt, find solutions, and be flexible. 

When a person experiences chronic stress, however, their body is unable to activate the brake, so cortisol levels are constantly high. 

Chronic stress levels can rise due to:

• Psychosocial processes, including individual, personality-related differences; mood; a lack of access to or knowledge about resources that can help to manage stress; and levels of stress reactivity. 
• Sociobiological factors, such as the way that society responds to sex, age, ethnicity, and race and exposure to health risks and medical treatment. Existing autoimmune conditions also increase stress levels. 
• Health behaviors and lifestyle, such as those mentioned above (smoking, drugs, sedentarism, etc.). Stress and lifestyle factors that increase autoimmune disease risk are interrelated. 

Chronic stress has numerous effects on the mind and the body. If chronic stress is experienced during a period of development, it is called toxic stress, as it can have a negative and long-lasting effect on how a body functions. 

Toxic or chronic stress and unhealthy lifestyle behaviors have wide-reaching effects on the neurological, immune, and endocrine systems. These factors increase inflammation and oxidative stress, which leads to immune system dysregulation. 

If a person maintains an unhealthy lifestyle and chronic or toxic stress, autoimmune diseases can develop. In fact, a vast body of research shows that toxic stress in childhood can significantly increase the risk of developing chronic diseases. 

Socioeconomic Factors

People living with chronic and autoimmune diseases face a number of unique challenges that adversely affect their health-related quality of life (HRQoL). 

These challenges aren’t just the result of difficulty with symptoms but also due to a number of socio-economic factors. This is especially true for those who are members of populations that have been historically marginalized, such as people who are:

• Black or brown
• Indigenous
• LGBTQIA2s+
• Living in low-income or impoverished communities/households
• Living with a disability
• Living with a history of trauma
• Living with a mental illness
• Prisoners or formerly incarcerated
• Refugees and immigrants
• Senior citizens
• Unemployed
• Women

Humans are a unique species in that we systematically treat people with certain identities, races, genders, and ethnicities differently to the extent that we build complex systems and institutions that make it significantly more difficult for marginalized people to access health-promoting living conditions. 

Living conditions that impact health and wellbeing include:

• The physical environment: access to clean air, water, and land; exposure to xenobiotics; access to housing, segregation
• The social environment: racism and discrimination, culture, and violence
• Economic and work environment: access to employment, income, and occupational hazards
• Service environment: access to health care, education, and social services

Living conditions can not only have a direct impact on chronic stress and exposure to toxins but also increase risky behaviors, including smoking, poor nutrition, low physical activity, participation in violence, doing drugs and drinking alcohol, and risky sexual behaviors. As described in the previous section, these conditions and behaviors can lead to chronic inflammation and oxidation, which is directly linked to an increased risk of autoimmune disease. 

Infections

The immune system exists to help keep our cells and organs safe from pathogens—bacteria, viruses, and fungi that can cause our body harm. If our immune system is not able to successfully neutralize the pathogen, it can lead to infection. 

Mild infections may be fought off by the adaptive immune system. In some cases, antibiotic medication is needed to support the immune system and kill the pathogen before it causes long-term harm. 

However, untreated and chronic infections can lead to immune dysregulation, systemic inflammation, and tissue damage. 

Some common microbes that, when they cause infection in the body, are linked to an increased risk of autoimmune and chronic disease include: 

• Epstein-Barr Virus (EBV)
• CMV
• C. tetani
• Saccharomyces cerevisiae
• E. coli
• K. pneumoniae P. mirabilis

One of the ways in which researchers have found that infectious agents can cause autoimmunity is through a mechanism of action called molecular mimicry. With molecular mimicry, autoantigens are mobilized and cannot tell between the body’s cells and the infectious agents. As a result, the body attacks and destroys its own cells, causing autoimmunity. 

Genetics

Some individuals have a genetic predisposition to developing autoimmune disease. Genetic predisposition is affected by the familial occurrence of an autoimmune disease (and the heritability of specific genes), gender, and age. 

Causative genes are not entirely understood, and many genes overlap. Genes are related to:

• Genetic transcription factors
• Immunological cellular and molecular signaling
• Cytokine functioning
• Intercellular pattern recognition receptors
• Membrane molecules
• Autoantigens

Some of the causative genes, or those known to influence a person’s susceptibility of developing certain autoimmune diseases, include: 

• Lupus: STAT4, BLK, IRFS, MAPK1
• Multiple Sclerosis: HLA-DRA, IL2RA, PTGER4
• Rheumatoid Arthritis: PTPN2, RBPJ, BACH2
• Type 1 Diabetes: CCR4, IL10, CD226
• Inflammatory Bowel Disease: IL 1R2, TYK2, IFIHI
• Psoriasis: IL23r, TRAF31P, REL, IL12B

Additionally, gender, race, and ethnicity are independent risk factors for autoimmunity. Sex chromosomes, hormonal differences, and systematic inequities play an interconnected role in the risk of autoimmunity. 

It is important to note that, because a person is more susceptible to an autoimmune disease due to genetic predisposition doesn’t necessarily mean that they are sentenced to developing the condition. Environmental factors, like lifestyle and stress exposure, can inhibit or initiate the autoimmune response. The study of the phenomena that cause a gene to be expressed or not is called epigenetics. 

Nutrition and Diet over a Lifetime

Nutrient intake affects our overall immune system function, especially T-cell function. White adipose tissue (fat tissue) and adipokines may perpetuate inflammation. 

Additionally, what we eat impacts microbiome and intestinal mucosal integrity. Malnutrition, a lack of consumption of phytonutrients, and poor intestinal microbiomes have a direct impact on immune health. 

There are diverse ways in which humans can adequately meet nutritional and dietary needs. However, there is a significant body of research that has demonstrated how some dietary patterns are harmful. Some known harmful dietary patterns are those that are: 

• High in trans fat
• High in sodium
• Low in micronutrient diversity
• Low in phytochemical and antioxidant intake
• Low in fiber
• Inadequate protein intake
• High in sugar 

Additionally, some nutrients and dietary components have been shown to have specific negative effects on the immune system and thus increase the risk of developing autoimmune disease. 

The Bottom Line: Inflammation and Oxidative Stress & Immune Disruption

What do the holistic and integrative factors that influence autoimmune disease risk have in common? They directly or indirectly cause oxidative stress, spark chronic and system inflammation, and ultimately disrupt the immune system, causing it to attack its own cells.  

When the body starts mistakenly attacking itself, it is called autoimmunity, and autoimmunity can lead to the development of discernable autoimmune diseases. 

Main Takeaways

Holistic health coaches have an important role in supporting their clients to prevent and manage health conditions. Autoimmune diseases are complex, have multiple causes, and can be difficult to manage. Understanding the causes of autoimmune diseases from a holistic and integrative perspective can help you to support clients diagnosed with an autoimmune disease and understand what is happening in their bodies. It can also help you incorporate a preventative approach into your coaching practice. 

References

1. https://www.health.harvard.edu/diseases-and-conditions/autoimmunity-indicators-on-the-rise-among-americans
2. https://pubmed.ncbi.nlm.nih.gov/29710102/
3. https://www.sciencedirect.com/topics/neuroscience/autoantigens
4. https://www.mdpi.com/1420-3049/21/5/559
5. https://plato.stanford.edu/entries/biomedicine/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824550/
7. https://www.sciencedirect.com/science/article/pii/B9780128164839000062?via%3Dihub
8. https://www.sciencedirect.com/science/article/abs/pii/S0889159103000333
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736192/
10. https://www.longdom.org/open-access/predictors-of-impaired-quality-of-life-and-work-disability-in-patients-with-systemic-diseases-43977.html
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342665/
12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225959/pdf/jcdr-8-WE01.pdf