Learn what Autoimmune disease is and the why what you do can radically influence your risk of disease and how it plays out in your life.

1. Healthy Living Lecture Series
Stephan Esser MD, USPTA

2. Understanding Autoimmune
Disease:
the
Attack from Within
Stephan Esser MD
Follow me @ EsserHealth
on Facebook and Instagram

3. Goals
• Review definitions and tenets
• Overview of the Statistics
• Visit the classroom: anatomy, physiology
• Brief review of common autoimmune dz.
• Propose some models for cause
• Review the influence of Lifestyle
• Discuss opportunities for prevention,
management and reversal

4. Definitions
• Auto-Immune Disease
– Auto = Self Immune= Defense, Protected
– “A disease in which the body misdirects an
immune attack against it’s own cells resulting in
damage and injury”

5. Why this matters?
• 3rd
most common category of disease in US
• 5-8% of population have an AI disease
• Approx. 20-50 million Americans
• 78% are women

6. Why this Matters?

7. Statistics

8. Statistics

9. What we know?
• AI Disease is common
• It can affect almost any tissue in the body
• Women are more commonly affected then
Men
• Each AI Disease has a unique predilection

10. Mini Med-School

11. The Immune System
• Immunity: The ability of the body to protect
itself from harmful environmental and
internal influences
– Composed of multiple organs, tissues and cells

13. Immune System
• Bone Marrow: Where immune cells are
formed
• Thymus: Small gland near the heart where
immune cells are educated
• Lymph Nodes: Small “organs” that function as
filters, short term storage and education sites
• Lymphatics: Highways of the Immune system
• Spleen: Where blood is filtered of old blood
cells and non “self” particles

14. Immune System
• Gut Associated Lymphatic Tissue (GALT)
– 70-80% of your immune system surrounds your
intestines

18. Types of Immunity
• Innate
– 1st
line of defense
– Basic, early, always ready
– Fever, Mucus, Macrophages etc
• Acquired
– 2nd
line of defense
– “Adaptive,” responds to stimulus
– Develops learned memory

19. Definitions
• Antigen: a toxin or other foreign substance
that induces an immune response in the body
• Antibody: a blood protein produced in
response to and counteracting a specific
antigen.

20. Other Factoids
• Infants lack fully developed immune systems
• Chronic Stress impairs immune function
• Inadequate Sleep impairs immune function
• Poor Nutrition impairs immune function
• With Age immune function declines

21. What we Know?
• Immunity is complex
• Immunity is tightly regulated
• Immunity has both basic and adaptive abilities

22. Back to the “Guts”

23. What we Know
• 80% of the immune system is in the Gut
• “Mucosal” layers are a primary interface
through which we develop immunity
• If “steps” are skipped/shortened,
early/inappropriate “exposure” can occur

24. How it all goes wrong?

25. The Theory of Autoimmune Disease and
Causation

26. Risk Factors

27. Symptoms vs Non-Symptomatic

28. • Treating Autoimmune Disease
– Conventional Approaches focus on:
• Suppressing the Immune Response
• Treating Symptoms
– Lifestyle Approaches focus on:
• Risk Reduction
• Trigger Avoidance
• Normalizing Immune Response
• Treating Symptoms

29. Theories on Causation
• 1: Leaky Gut/Dysbiosis
• 2: Toxin Exposure/Molecular Mimicry
– Infectious Agent, Allergen, Toxin
• 3: Hygiene Hypothesis

30. • Leaky Gut Hypothesis
– Dietary/Stress/Exercise Exposures result in loose
cell membrane connections in the gut
– Incompletely processed materials ( Proteins,
bacteria, etc) enter the blood stream
– Abnormal signaling and autoimmune dysfunction
occurs

31. Back to the “Guts”

32. Exposures
• Infectious: Parvovirus B19, Coxsackie B4, HSV-1, Group
A/B Strep, Mycobacterium Avium, Salmonella, Shigella
etc
• Allergen/Toxin: Gluten, Food Additives, Preservatives,
Silica, Bleomycin, Vinyl Chloride, Dairy/Casein, Soy, Nuts,
Nightshades, Epoxy Resins, hydrazines, tartrazines, hair
dyes, trichloroethylene, industrial emissions, pesticides,
hazardous wastes etc, etc

33. • “Glucose, salt, emulsifiers, organic solvents,
gluten, microbial transglutaminase,
and nanoparticles,” food colorings, dyes,
preservatives etc increase intestinal
permeability

34. Molecular Mimicry

35. The hygiene hypothesis proposes that as the living environment
is improved, children become less exposed to infectious agents,
which leads to inadequate maturation of their immune systems.
The hygiene hypothesis proposes that as the living environment
is improved, children become less exposed to infectious agents,
which leads to inadequate maturation of their immune systems.

36. Theories
• Genetically Primed Individual
• Gut Integrity is Lost/Compromised Immune
State
• Toxic/Infectious Exposure
• Misdirected or Overzealous Response

37. The Result
• Skin: Psoriasis, Lupus, Scleroderma,
Dermatomyositis etc
• Joints: Lupus, Rheumatoid Arthritis,
Polymyalgia Rheumatica etc
• Nerves: Multiple Sclerosis, Guillain-Barre
Syndrome etc
• Organs: Type 1 Diabetes, Autoimmune
Hepatitis, Hashimoto’s Thyroiditis etc

38. Prevention
• Normalize Gut Permeability
• Avoid/Minimize Toxic/Infectious exposures
• Limit “friendly fire”

39. Prevention
• Reduce Gut Permeability
– Increase Fiber
– Enhance “probiotic” health
– Primarily consume whole minimally processed
foods
– Avoid food additives, processing
– Minimize or eliminate Meat, Dairy use especially
– Avoid Gluten as a “primary calorie” source

40. Gut Permeability
• Fiber:
– Cultivates “healthy bacteria”
• Reduces toxin production
– Reduces Bowel exposure to toxins
• Enhances Bowel Motility
– Crowds out low fiber foods

41. Gut Permeability
• Probiotic Health
– Synergistic Bacteria
– Alters Immune Modulation, Inflammation, Disease
– Eg:
• Probiotic as effective as Mesalamine for Ulcerative
Colitis Gut 2004
• Gut Biome is altered in patient’s with Hashimotos
Thyroiditis Thyroid 2018
• Probiotics help reduce Rheumatoid Arthritis
Inflammation Annals of Rheumatic Disease 2018

42. • Plants: Vegetable and Fruit Consumption
– Only Source of Fiber
– Alter Inflammatory cell activity Frontiers in Immunology 2018
– Alter Bacterial Species in the Gut Nutrients 2018
– “Prevent CNS autoimmunity and warrants a focus on nutritional
approaches in human MS” Scientific Reports 2018
– Reduces symptoms and progression of Rheumatoid Arthritis Scandinavian
Journal of Rheumatology 2001
– Fibromyalgia pain and symptoms improve BMC Complementary and Integrative
Medicine 2001
– Reduce the risk of Inflammatory Bowel Disease American Journal of
Gastroenterology 2011
– Prevents recurrence in 94% of semivegetarian diet vs only 33% of
those on omnivorous diet World Journal of Gastroenterology 2010

43. Gut Permeability and Toxins
• Remember Molecular Mimicry
– Avoid Chemical Toxins as possible
• Purify Water
• Minimize plastics when possible
• Use Glass, Stainless Steel, Wood
• Eat Organic, Wash fruit/Veggies well
• Minimize food processing

44. Meat and Dairy
• Ultimate “Molecular Mimicry” when leaky gut
– Children who consume most meat and dairy have highest rates of T1D Clinical
Nutrition 2000
– High fat meals increase gut permeability Clinical and Translational Gastroenterology 2013
– Inc. Meat and Dairy appears to inc. risk of UC and Crohns JGH 2008
– Inc. Meat and Dairy Inc. risk of IBD AJG 2010 Inc risk of SLE TJEM 1993 IMJ 2015
– Inc. Meat, Inc relapse rate in Ulcerative Colitis Gut 2004
– Those who ate highest levels of meat have highest rates of “Polyarthritis”
Arthritis and Rheumatology 2004
– Those who ate most fruits and veg. had lowest rates of Psoriasis BJD 1996
– Dairy Consumption was associated with Developing MS Neuroepidemiology 1992
– Animal Based Foods and High Fat Foods increased risk of MS IJ Epidemiology 1998
Mixed data since
– Meat consumption may inc. risk of RA Scan. Jrn. Of Rheum. 2006
– Meat consumption increased pain and symptoms of RA BR. Jnl. Nut 2000

45. Gluten and AI Disease
• Gluten
– Gluten Sensitivity/Allergy appears to be related to the risk of Hashimotos,
T1D, Grave’s Disease etc Nutrients 2018
– Genetically at risk Children who consumed increased gluten consumption
were more likely to develop T1D. Am. Diabetes Association 2018
– Gluten-Free diets can reduce symptoms in Non-Celiac Autoimmune
Diseases Nutrition Reviews 2017, Int. Jnl of Celiac Disease 2017

46. • Avoid/Minimize Toxic Exposures
– Minimize number of “drugs” you need
– Use “natural” substances for food containers,
water containers etc
– Strive for “natural” skin care, sun protectants,
soaps, cleaners
– Use appropriate protection when working with
chemicals, dusts etc ( Face, Eyes, Skin, Lungs etc)
– Purify water, Change air filters

47. • Infectious Exposures
– Minimize sick contacts
– Use appropriate precautions
– Enhance Immune function to minimize duration
and extent of symptoms if infected
– Minimize meat and dairy and contaminated foods

48. “likelihood of contamination of raw milk with MAP in most studied regions is substantial. The presence of
MAP in raw and pasteurized milk has been the subject of several studies which show that pasteurized milk
is not always MAP‐free and that the effectiveness of pasteurization in inactivating MAP depends on the
initial concentration of the agent in raw milk.
The most recent studies indicated that beef can be contaminated with MAP via dissemination of the
pathogen in the tissues of infected animals. Currently available data suggests that the likelihood of dairy
and meat products being contaminated with MAP on retail sale should not be ignored.”
“likelihood of contamination of raw milk with MAP in most studied regions is substantial. The presence of
MAP in raw and pasteurized milk has been the subject of several studies which show that pasteurized milk
is not always MAP‐free and that the effectiveness of pasteurization in inactivating MAP depends on the
initial concentration of the agent in raw milk.
The most recent studies indicated that beef can be contaminated with MAP via dissemination of the
pathogen in the tissues of infected animals. Currently available data suggests that the likelihood of dairy
and meat products being contaminated with MAP on retail sale should not be ignored.”

49. Meat Contamination
• Retail Meat is contaminated Applied and Environmental Microbiology 2001
– 90% of stores had contaminated chicken
• 70% Chicken with Camplyobacter
• 38% Chicken with E.Coli

50. Sleep and Stress
• Sleep < 7 hrs in an at risk population may
increase risk of Lupus Lupus 2018
• Stress Related Disorders Inc. risk of AI Dis. JAMA
2018
• Stress may Inc risk of Lupus Nature Reviews 2018

51. What we Know?

52. Your Prevention Plan
• Eat
– More minimally processed pure plant based foods
– Minimize Gluten
– Minimize or Eliminate Meats and Dairy
• Avoid
– Repeat Infections, Food Sources with infectious
agents
– Toxins/ Drugs where possible
• Maximize
– Sleep, Stress reducing behaviors

53. Your Treatment Plan
• Consider a period of an elimination diet to
– Strip out common allergens from your diet
• Gluten, Nuts, Eggs, Soy, Nightshades
• Identify Personal Triggers
– Rebuild your intestinal wall
• Supplement with Probiotics
– Reduce Inflammatory molecule production
• Enhance Immune System
– Increase rest/sleep Reduce Chronic Stressors
– Vitamin D ( Sunlight), Selenium, Vit C, Omega 3’s

54. Plan
• Evaluate your risk
– Personal, Strong Family History, Past Exposures
• Develop a Goal Oriented Plan
– Prevention/Symptom Reduction/ Medication
Reduction/ Reversal
• Evaluate Success every 3 months and modify

55. Conclusion
• Autoimmune Disease is a complex,
multifaceted process
• Both Genetic and Environmental factors
influence onset and progression
• There are many “choices” we can make which
can reduce risk and improve management

56. Goals
• Keep Learning
• Apply the Science to your life
• Transition from Surviving to Thriving

57. Thank You!
Stephan Esser MD, USPTA
Follow me on Instagram or Facebook
@EsserHealth