Sleep Problems? Extreme Fatigue? Joint Pain? Mental Tiredness?
Autoimmune disorders come in many sizes and flavors. They are called by many fancy names. But they share one simple fact. All autoimmune disorders are a problem with the body’s immune system attacking itself.
A runaway, out of control and confused immune system that is hyped up to attack itself by accident by something called antibody molecular mimicry. The causes may be varied but the end result is the same.
There are about 140 different types of autoimmune diseases ranging from Multiple Sclerosis (MS) to Type 1 Diabetes (T1DM) to Lupus to Hashimoto’s of the thyroid to a few vasculitides. For the purpose of this segment I will be discussing Vasculitis in a bit more detail and the use of LDN (low dose naltrexone) a common intervention as well.
Vasculitis is an autoimmune disorder heralded by blood vessel involvement. Blood vessels large and small, arteries, veins and capillaries can all be involved. The diseases are usually classified by the size of the blood vessels involved and/or the organs that are affected. There are several triggers and different regions of the body that can be affected. In general, inflammation develops in blood vessel walls which cause swelling, narrowing of the lumen and weakness of the structural wall.
When swelling occurs there is usually pain and warmth of the vessel and surrounding areas. When there is narrowing, the blood flow through the artery or vein is compromised and distal organs can be affected. In the case of arteries, should there be drastic narrowing of the vessel lumen, there would be a reduction in blood flow. This reduction in blood flow carrying oxygen via red-blood-cells (RBC) may cause injury to tissue, known as ischemia.
We see this with a particular type of vasculitis called Buerger’s disease, when fingers and distal extremities may auto-amputate due to profound ischemia. When weakness of the vessel wall occurs, there can be a bulging or aneurysm formation of the affected location. When the aneurysm is of significant size, pooled blood can coagulate and form clots. This thrombotic state can raise the risk of distal thromboembolic phenomena that can cause injury to organs.
The Underlying Infection
Inflammation is sparked by some type of trigger, whether it is caused by an underlying infection (virus, microbe) or another environmental agitatent. The tissue of the blood vessel’s inner lining called the endothelium become inflamed when immune cells become hyperactive and attack native tissue. This attack is perceived as a defensive maneuver to destroy a foreign intruder like a virus, but the body’s immune system is tricked and the immune cells actually attack the “self”. This is the definition of autoimmune. When the site of attack is a blood vessel, we call this a vasculitis. While most vasculitis is due to inflammation and autoimmune disorders, occasionally cancers such as lymphoma and leukemia can be the root cause. There are even cases of drug-induced vasculitis.
Problems really occur when distal organs or systems are affected. A severely narrowed blood vessel or even occluded due to severe inflammation will not allow the passage of oxygen containing RBCs and anything downstream suffers hypoxia. This leads to necrosis or death of tissue starved of oxygen. End organs such as kidneys and lung tissue can be destroyed. When the vessel wall becomes weakened to the point of dilating or expanding, the integrity may be so stressed the vessel ruptures. Surgical intervention is sometimes necessary to repair a damaged vessel before it ruptures.
There are different types of vasculitis and different end organs affected. While the pathological and histological appearance may remain the same, the variance occurs with the size of the vessels involved and the end organs involved. For example when large vessels are involved you have conditions such as Behcet’s disease, which involve painful ulcers in the mouth and genital area with the uvia of the eyes often involved. It is usually specific to men in their 30’s and of Mediterranean descent. Another is Cogan’s syndrome which is more systemic and can lead to skin changes and eye inflammation and even hearing loss. Giant Cell arteritis occurs in the artery of the temple of our head and usually affects older folks. Headaches, scalp tenderness and pain are harbingers of this condition and without treatment can lead to sudden vision changes or loss.
Polymyalgia Rheumatica (PMR) affects the joints and muscles causing pain, stiffness and weakness, mostly of the proximal muscle groups of the shoulder and pelvic girdle. Takayasu’s arteritis (KA) while rare usually affects Asian teenagers and women. KA can cause destruction of the aortic arch. Malaise, fever, weight loss and sore joints usually precede vessel involvement.
Medium sized vessels are affected in a few other disorders such as Buerger’s disease and Raynaud’s phenomenon. Buerger’s is also known as thromboangitis obliterans which can cause disruption of blood flow to fingers and toes with necrosis and loss of those affected limbs. Seen very often in men in their 30’s and associated with cigarette smoking and elevated serum homocysteine levels. Raynaud’s is a commonly seen malady where extremities such as fingers get cold and turn “white” with decreased blood flow when exposed to a trigger (like touching a cold object).
A rare childhood disease known as Kawasaki disease (KD) where the walls of vessels systemically are inflamed and all sizes are involved and can be damaged with aneurysms. Also known as muscocutaneous lymph node syndrome as a child presents very often with red patches on mucous membranes and a red rash on the skin. Some serious cardiac issues may occur in these children if not treated early. It is successfully treated with medication if caught early and rarely do surgeons get involved to repair enlarged weak blood vessels.
Polyarteritis nodosa can present with lace like rash, bumps under the skin, anemia is yet another manifestation of a vasculitis. Other conditions such as Eosinophilic granulomatosis with polyangiitis (EGPA) aka Chung-Strauss Syndrome, affecting skin, lungs, kidneys and nervous system. Cryoglobulinemic vasculitis, IgA vasculitis (Henoch-Schonlein Purpura), hypersensitivity vasculitis and microscopic polyangitis are others. Wegener’s granulomatosis (GPA) is still another variety that affects the upper airway, lung and kidney.
Signs and symptoms can include fever, loss of appetite, weight loss, fatigue and generalized pain. Very often there are skin manifestations. Organs involved can include skin, joints, the lung, the GI tract, upper airway tree (nose ears), eyes, the brain and nervous system tissue. It can be quite disturbing for a parent to find their child with a very high fever, mucous membrane lesions and peeling skin. These are some classic signs of Kawasaki Disease, a rare type of vasculitis in children.
Tests that are used to diagnose vasculitis are: CBC to rule out anemias; an antineutrophilic cytoplasmic antibodies test (ANCA) where certain antibodies are produced in some vasculitis. The Erythrocyte Sedimentation Rate (ESR, aka Sed Rate) is a very common and important test in evaluations. Another inflammatory marker often ordered by doctors is the C-reactive Protein (CRP). As an inflammatory disease, inflammatory biomarkers are important tests for diagnosing these disorders. Sometimes biopsy of an affected vessel is important as histologic evaluation can help make a diagnosis. Other studies such as an EKG and ECHO to measure cardiac function, a Chest x-ray for pulmonary issues and a urinalysis to check for renal function and involvement are ordered. Ultrasound, CT and MRI scans may be helpful as well as angiography which visualizes blood vessels that may be narrow, swollen, deformed or obstructed.
Treatments vary according to what type and the severity of the disease. Also considered in a medical regimen is what end organs are involved. Most treatment is by medication, but on occasion surgery is called for. Many can be treated with over-the-counter pain medications in the class called NSAIDS (Motrin, Aleve or aspirin). Other choices are corticosteroids like prednisone. Some physicians may prescribe cytotoxic medications. These types of medications will suppress or kill cells that cause inflammation. Some examples are cyclophosphamide, methotrexate and azathioprine. In pediatric cases of Kawasaki disease, high doses of aspirin are used in combination with intravenous immune globulin. To repair bulging vessels, vascular surgeons may have to go in and remove or repair aneurysms.
There are no set guidelines for prevention of vasculitis, however, keeping a healthy immune system, proper diet, avoiding environmental toxins and stimulants such as tobacco smoking and doing what it takes in higher risk patients to avoid triggers can help lower the risk of getting this disorder. As fitness professionals, being observant with clients when they are ill appearing and may present with skin manifestations, should be directed to their healthcare providers if they have not been evaluated.
If any one of these is an issue with you and your doctors are unable to find a root cause or even prescribe adequate therapy it may be time for the providers at Carolina Holistic Medicine to have a look.
Low-Dose Naltrexone (LDN)
Low-dose naltrexone holds great promise for the millions of people worldwide with autoimmune diseases or central nervous system disorders or who face a deadly cancer. In the developing world, LDN could provide the first low-cost, easy to administer, and side-effect-free therapy for HIV/AIDS.
Naltrexone was first created in 1963; the drug was approved by the FDA in 1984 in a 50mg dose for the purpose of helping heroin or opium addicts and alcoholics, by blocking the effect of such drugs on opioid receptors. By blocking opioid receptors, naltrexone also blocks the reception of the opioid hormones that our brain and adrenal glands produce: beta-endorphin and metenkephalin. Many body tissues have receptors for these endorphins and enkephalins, including virtually every cell of the body’s immune system.
In 1985, Bernard Bihari, MD, a physician with a clinical practice in New York City, discovered the effects of a much smaller dose of naltrexone (approximately 3mg once a day) on the body’s immune system. He found that this low dose, taken at bedtime, was able to enhance a patient’s response to infection by HIV, the virus that causes AIDS. [Note: Subsequently, the optimal adult dosage of LDN has been found to be 4.5mg.]
In the mid-1990’s, Dr. Bihari found that patients in his practice with cancer (such as lymphoma or pancreatic cancer) could benefit, in some cases dramatically, from LDN. In addition, people who had an autoimmune disease (such as lupus) often showed prompt control of disease activity while taking LDN. There was much research done in the mid-1980s thru present day; most of the research has been in Europe and especially England.
LDN boosts (or better yet corrects an abnormal) immune system, activating the body’s own natural defenses. It is helpful in immunosuppressive diseases, HIV, Lyme Disease and autoimmune disorders.
Up to the present time, the question of “What controls the immune system?” has not been present in the curricula of medical colleges and the issue has not formed a part of the received wisdom of practicing physicians. If the immune system is hyperactive (or you have autoimmune disorders) the prevailing theory is to “tame it” with immunosuppressants and corticosteroids (Biologics & Prednisone). However, Functional Medicine doctors attempt to “enhance or correct the abnormal immune system, not “suppress it”. Nonetheless, a body of research over the past two decades has pointed repeatedly to one’s own endorphin secretions (our internal opioids) as playing the central role in the beneficial orchestration of the immune system, and recognition of the facts is growing.
Witness these statements from a review article of medical progress in the November 13, 2003 issue of the prestigious New England Journal of Medicine: “Opioid-Induced Immune Modulation: …. Preclinical evidence indicates overwhelmingly that opioids alter the development, differentiation, and function of immune cells, and that both innate and adaptive systems are affected. Bone marrow progenitor cells, macrophages, natural killer cells, immature thymocytes and T cells, and B cells are all involved. The relatively recent identification of opioid-related receptors on immune cells makes it even more likely that opioids have direct effects on the immune system.”
The brief blockade of opioid receptors between 2 a.m. and 4 a.m. that is caused by taking LDN at bedtime each night is believed to produce a prolonged up-regulation of vital elements of the immune system by causing an increase in endorphin and enkephalin production. Normal volunteers who have taken LDN in this fashion have been found to have much higher levels of beta-endorphins circulating in their blood in the following days. Animal research by I. Zagon, PhD, and his colleagues has shown a marked increase in metenkephalin levels as well. When Dr. Bihari was alive he said that his patients with HIV/AIDS who regularly took LDN before the availability of HAART were generally spared any deterioration of their important helper T cells (CD4+).
In human cancer, research by Dr. Zagon over many years has demonstrated inhibition of a number of different human tumors in laboratory studies by using endorphins and low dose naltrexone. It is suggested that the increased endorphin and enkephalin levels, induced by LDN, work directly on the tumors’ opioid receptors — and, perhaps, induce cancer cell death (apoptosis). These are the mu-, kappa- and delta- opioid receptors acting as antagonists as well as non-opioid receptors known as Toll-Like Receptor 4 (TLR-4) receptors. In addition, it is believed that they act to increase natural killer cells and other healthy immune defenses against cancer. Fascinating scientific research in the area of HPA (hypothalamus-pituitary-adrenal) axis and the stimulating hormone of the adrenals (ACTH) for the production of Cortisol and DHEA and how it relates to LDN has come to print in medical journals. The precursor of ACTH is a larger molecule called pro-opiomelanocortin (POMC). Enzymatic metabolism of the larger POMC produced in the brain and other tissues is cleaved to provide ACTH a hormone that helps release cortisol from the adrenals. Low levels of cortisol especially in the morning can contribute to low-energy and fatigue in many individuals with stress induced fatigue and low-energy complaints.
POMC is a precursor protein to most endorphins, those neuropeptides that have an effect on release of Dopamine (the happiness hormone) and have a part to play on other physiological structures, both neuronal and immune.
Research on Naltrexone (LDN) has shown effects on endorphins and POMC. And many uses of this treatment for Autoimmune disease, Multiple Sclerosis (MS), Hashimoto’s Thyroid disease, Chronic Pain, CFS, IBS and even a multitude of cancers.
In general, people with diseases that are partially or largely triggered by a deficiency of endorphins (including cancer and autoimmune diseases), or are accelerated by a deficiency of endorphins (such as HIV/AIDS) can find resolution with LDN. Restoration of the body’s normal production of endorphins is the major therapeutic action of LDN.
Our center takes autoimmune disorders very seriously and we always look for root cause and exacerbating factors. The center’s providers are especially skilled at diagnosis and therapies to help a wide range of autoimmune disorders and immune deficiencies. We are also skilled and trained as Lyme Literate Medical providers (LLMD) and know how to diagnose and treat acute and chronic Lyme disease and other tick borne co-infections. Dr. Saleeby has been a member of ILADS and has precepted under the the tutelage of Dr. Richard Horowitz a world renown Lyme Disease specialist.
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