Conventional medical intervention for a variety of autoimmune diseases has been disappointing at best. Therapy is generally initiated to control some of the symptoms and slow the progression of disease. However, conventional treatment does not offer a "cure" and long term prognosis for remission still remains poor. Also, many of the drugs used to treat these disorders have serious side-effects such as bone loss, ulcers, joint and organ damage and a further worsening of immune function and symptoms over time. Women should demand a greater focus and more research dollars be spent on autoimmune disease since it is significantly more likely to affect a woman in her lifetime compared to a man.
Some studies have focused on an estrogen connection with respect to autoimmune disease. In the Nurses Health Study ever users of estrogen replacement had a relative risk (RR) for lupus of 2.1, current users RR 1.2 and past users RR 1.8. A proportional increase in risk was observed with the duration of use of postmenopausal hormones. More recent studies have shown that for some types of autoimmune disorders exogenous testosterone replacement may actually be therapeutic (e.g. lupus, rheumatoid arthritis). DHEA supplementation of 200 mg daily has been shown to benefit lupus patients. A theoretical article on melatonin suggested it may benefit MS patient since melatonin modulates the thermogenic regulatory mechanisms of the pineal gland. Additionally, many American women have "hyperestrogenism" or estrogen dominance due to dietary factors such as estrogens added to livestock that finds its way into meat, chicken, veal and dairy products. Also, two-thirds of Americans do not eat a single fruit or vegetable on a given day. Fruits, vegetables, and legumes are important sources of phytohormones which can modulate estrogen levels in the body by enhancing the metabolism of estradiol to estrone and finally to estriol. High levels of estradiol have repeatedly been implicated in breast cancer. Japanese women and other cultures eating a more plant based diet that is also rich in soy appears to protect against many of the negative effects of having high estradiol levels. It would be interesting to see if there is a connection between phytohormone ingestion (e.g. vegetables, soy) and prevention of autoimmune disease.
Surprisingly, scientific studies have shown that specific dietary supplement, dietary modification and lifestyles changes may greatly benefit patients with autoimmune disease as demonstrated by extended clinical remissions, improvements in symptoms and/or reduction in the dosage of steroids and other drugs used to control the disease. Although a more natural intervention is best utilized at the very onset of disease, it can also be combined with conventional therapy to assist in symptom relief and help lessen the side effects with later stage patients. Despite the significance of results, further research into nutritional intervention for autoimmune disease has been quite slow coming.
DIETARY INTERVENTION
Low fat diets have been reported to benefit patients with lupus, multiple sclerosis (MS), scleroderma and rheumatoid arthritis (RA). Very long term studies of 34 and 36 years, have shown that patients following a very low fat diets (<20 grams fat/day) experienced significantly less deterioration and much lower death rates when consuming low fat diets. Approximately 95% of patients followed during these long term studies survived and remained physically active. An even lower fat diet (10-15 grams of fat/day) resulted in better improvement in energy and fatigue levels. In patients who consumed >20 grams of fat/day the death rate approached 80%. Low fat diets could potentially modulate prostaglandin metabolism, specifically arachidonic acid and inflammatory prostaglandins. High meat diets are rich in arachidonic acid and high fat diet are generally quite high in linolenic acid - both of which may result in an imbalance of prostaglandin metabolism by encouraging the production of inflammatory prostaglandins. Also, lower fat diets would result in lower levels of oxidative stress, and those consuming low fat diets would be eating a more vegan based diet that would provide a variety of potent plant antioxidants.
Vegan diets and gluten-free diets have been shown to benefit RA patients, patients with inflammatory bowel disease, psoriasis eczema and those with dermatitis herpetiformis. Milk and meat consumption has been shown to increase the incidence of MS. Overall patients with autoimmune disease in particular those with lupus, have a much higher incidence of food and other allergies compared to normal healthy patients.
OMEGA-3 AND OMEGA-6 FATTY ACIDS
Numerous animal models of lupus have demonstrated marked protection from kidney disease, increased lifespan and autoimmune suppression. Human clinical studies have shown that fish oil can induce clinical remission without any negative side-effects. Fish oil supplementation has also been shown to benefit patients with MS with significant reductions in neurologic scores. There are many studies showing a beneficial effect of fish oil supplementation in patients with RA. Supplementation has been shown to reduce the use of NSAIDs and other medications and improve RA symptoms such as joint tenderness and joint swelling. Clinical benefit of fish oil supplementation has also been observed in patients with disorders such as Raynaud's syndrome, eczema and psoriasis. Excellent results have been achieved using fish oil supplementation in patients with Crohn's disease and ulcerative colitis and appears to work as well as if not better than conventional drug treatment with a lack of side effects. In general, studies have used high dose fish oil supplementation, from 12-18 capsules per day. However, co-administration of a very low fat diet may reduce the quantity of fish oil required to improve a patients condition and/or induce remission.
Studies using Evening Primose Oil (EPO) in autoimmune disease have been mixed, perhaps due to the different doses used in studies. While EPO is a significant source of gamma-linolenic acid (GLA) and provides approximately 45 mg per capsule of GLA, each capsule is also a significant source of linoleic acid (approximately 120 mg). In order to get a therapeutic benefit of EPO, 6-12 capsules have been used in studies (both human and animal) for disorder such as lupus, MS, rheumatoid arthritis, scleroderma, eczema, psoriasis. In human studies of RA, higher doses of GLA (approximately 1.4 to 2.4 grams) from capsules that provide approximately 240 mg GLA per capsule (and very little linoleic acid) have yielded consistently better results. Signs and symptoms of disease activity, tender joints, and swollen joints were significantly reduced. Theoretically, one may be able to obtain similar results by lowering the fat content of the diet and using lower doses of GLA.
ANTIOXIDANTS
Patients who are chronically ill with autoimmune disease have consistently higher levels of oxidative stress and lower levels of antioxidants. Antioxidants protect cells and organs from environmental insults and play a critical role in liver detoxification pathways. However, studies have generally looked at the effects one antioxidant at a time on disease progression. The issue with this type of research is that unfortunately, supplementation with just one antioxidant can potentially induce oxidative stress. For example, since vitamin E is a polyunsaturated fat, if given alone, it could potentially oxidize. When given concomitantly with vitamin C, ascorbic acid will prevent vitamin E oxidation and regenerate vitamin E. There are numerous human and animal studies elucidating the synergy between antioxidants. However, this synergy is still largely ignored in autoimmune clinical research. Studies have shown that vitamin E may be beneficial to patients with discoid lupus with complete clearing at very high doses of 900-1600 IU. Studies have also shown beneficial effects using high dose vitamin E with ulcerative colitis, and other forms of autoimmune disease as well. Also, vitamin C, selenium, beta-carotene, vitamin A have also been shown to be beneficial for a variety of autoimmune diseases, generally at doses significantly higher than the RDA (or RDI). Doses used are generally: vitamin C 1000 mg or higher; selenium 100 mcg or higher; beta-carotene 25,000 IU or higher, and vitamin A 25,000 IU or higher. Studies that have combined antioxidant supplements, have generally yielded the best results. Also, vitamin E is necessary when taking an essential fatty acid supplement since it will help protect the fatty acid from oxidizing. Lower fat diets may also reduce the dose of antioxidants required to reduce oxidative stress and decrease symptoms so that doses of 100,000 IU of vitamin A used in some studies, may not be necessary. What is surprising is that while excellent results were achieved using vitamin E supplementation with lupus and scleroderma patients, there is a surprising lack of studies using vitamin E with MS patients, excepts for just a few studies that combined selenium, vitamin C and vitamin E. In reviewing each antioxidant individually, it is equally surprising that when great results were obtained for a particular autoimmune disease, it was not necessarily repeated for another disease. In general, it would make greater sense to supplement all major antioxidants given their synergy, their role in modulating essential fatty acid metabolism to favor anti-inflammatory prostaglandins (which is why they work well with essential fatty acid supplements) and their ability to quench free radicals and prevent organ and cellular damage.
B-VITAMINS
As with the antioxidants, different B-vitamins have been the focus of research with different autoimmune diseases. In general, the research has shown that some B-vitamin deficiencies have been associated with autoimmune disorders and therapy with certain B-vitamins appear to improve the symptoms of autoimmune disease. For example, a B6 deficiency may predispose a person to MS, while high dose pantothenic acid supplementation (6-10 grams daily followed by a maintenance dose of 2-4 grams/day) has been shown to benefit lupus and RA patients. Doses of para-amino benzoic acid (PABA) of 12 grams per day have been shown to benefit scleroderma patients. As with the antioxidant research, the B-vitamin research has also followed the "magic bullet" protocol of generally research one particular B-vitamin at a time. Also, as with antioxidants, B-vitamins do not operate in a vacuum. B-vitamins are also synergistic in terms of being co-enzymes, modulating essential fatty acid metabolism and neurotransmitter metabolism and in the Kreb's cycle to yield ATP. Therapeutic intervention trials with B-vitamins have used levels substantially above the RDA (or RDI).
THE MERCURY DEBATE
Mercury is a potent neurotoxin. It induces a systemic autoimmune condition in genetically susceptible mice. These animals also have a narrow safety margin compared to non-genetically susceptible mice. One study revealed death rates from MS are linearly related to the numbers of decayed, missing and filled teeth in 6 Australian and 48 American states and in 45 Asian and European countries. This compelling evidence has prompted many practitioners to advice patients to have mercury amalgams removed. Anecdotal evidence of patient improvement have been reported by numerous practitioners.
SUMMARY
Since the best therapy is that which can at worst do no harm, it seems prudent to recommend dietary intervention as well as antioxidant, B-vitamin and essential fatty acid supplementation. Some practitioners recommend supplementation of both fish oil and GLA. One does not have to forgo their conventional therapy while initiating these other therapeutic modalities. DHEA, testosterone and melatonin may also provide benefit. However, it would be recommended to monitor serum or salivary levels of these hormones to make sure that patients remain within the normal range for these hormones.
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