Hello, hello. Today we're going to be talking about autoimmunity. It's such a confusing topic, with quite a bit of uncertainty and a lot of unknowns.
We see a lot of these processes during our routine check-ins and reveal sessions. For Christmas this year, we gifted our children the comprehensive lab panel we do for all our new patients. They range in age from 23 to almost 32, and they're very healthy, active, involved people — and some things came up, as they often do. So you really have to come at a reveal assessment from a perspective of "knowledge is power." We've also had a lot of patients where autoimmunity has shown up recently, which is why we decided this was a good topic.
When I look at the labs we draw, I feel like probably half of everybody we see has some type of autoimmune finding — rheumatoid, ANA, thyroid. When you bring in the general population, there are a lot of folks with autoimmune issues, and most don't even know it.
We are not autoimmune specialists or rheumatologists by any means. However, just like everything else we look for in our assessment, there are things that can be seen early and better handled when found early. Today we hope to give people clarity about what autoimmune disease really is — which is confusing and hard to explain — and reassurance that it's not the end-all problem or a death certificate. There are practical next steps you can take to help control or prevent autoimmune disease.
Autoimmunity 101
Simple definition: autoimmunity is basically an immune dysregulation. Having a good immune system is important — when we get exposed to viruses or bacterial infections, our immune system produces antibodies to destroy or protect us from the insulting agent. But when the immune system becomes dysregulated, it can produce antibodies that see our own tissues as foreign or as invaders, and that's when autoimmune disease develops.
A few of the diseases included under autoimmune: Hashimoto's, rheumatoid arthritis, lupus, psoriasis, celiac, MS, type 1 diabetes (which is actually an autoimmune disorder), and autoimmune hepatitis. A newer one is POTS — postural orthostatic tachycardia syndrome — which we see quite often. Even symptoms of fibromyalgia can be mistaken; a lot of people say, "I have fibromyalgia, I always have achy joints and muscles." Is that an inflammatory process, or an autoimmune one?
Inflammation vs. Autoimmunity
That's a good segue into the difference between inflammation and autoimmunity, because we look for both. Autoimmune disease is where we produce antibodies that create an inflammatory response driven by that antibody reaction. But we can have inflammation not related to allergy or autoimmunity — getting a splinter creates inflammation, and having problems with certain foods creates inflammation in the gut. We can measure the amount of inflammation in patients; there are biomarkers that tell us that.
Why Autoimmunity Seems to Be Increasing
Why does it feel like autoimmune problems are increasing? It's a huge question, and I wish I had the answer, but we have theories. Is it genetic, or are there triggers — toxins, pollution, our food system? Common contributors would be infections (viral and bacterial), gut permeability and dysbiosis, chronic stress and trauma load, nutrient depletion, mold and toxicity exposures, and metabolic dysfunction and inflammation. There's not one thing you can put your finger on — it's multifactorial. It's not just one thing; it's the total burden on the system. That's why there are multiple ways we can help patients reduce that total burden to calm the inflammatory immune response. We may not eliminate it, because there's more to it than we understand, but we can start picking out things that could flare it up.
Autoimmunity Is Showing Up Younger
We're seeing autoimmunity show up younger and younger — there's not really an age predominance, though we do see more in midlife. Is that partly because the younger population doesn't get labs drawn? We've seen many people in their 20s getting labs from a health-conscious standpoint and identifying, "Yeah, I've got a problem I need to do something about." Knowledge is power — if you know what's going on, you can start to improve the situation and avoid flare-ups, hopefully delaying or offsetting the chronic disease that can develop.
Midlife is potentially just an amplifier of what's been brewing undetected. Hormonal shifts can unmask immune issues, life stress is often higher (children, aging parents, sleep problems), and metabolic flexibility often declines — all of which can affect the immune system and bring things to the surface. To use the radio analogy: midlife isn't the cause of autoimmunity, but it can turn the volume up. The radio's on, but what we do and expose ourselves to turns up the volume — so we want to minimize that exposure to turn the volume down and reduce symptoms.
Understanding a Positive ANA
Something that's come up a lot recently is a positive ANA with no diagnosis but a feeling of not being normal. ANA is antinuclear antibodies. A positive ANA is common and not automatically a diagnosis of autoimmune disease — it's a screening test. With an ANA you also get a titer, which signals how strong the antibody response is, along with a pattern. The analogy we use is a smoke alarm: the ANA is the alarm, the titer tells us how loud it is, and the pattern tells us where to look next. From there we can get confirmatory labs to look deeper.
Hashimoto's Thyroiditis
One of the most common autoimmune diseases we see is Hashimoto's thyroiditis. We have a whole other podcast on the thyroid, but just scratching the surface: a person can have normal TSH — the routine thyroid lab — and still have antibodies directed at their thyroid, which is Hashimoto's. Normal lab values in these areas aren't everything.
For patients already diagnosed with Hashimoto's, once they start thyroid replacement they're typically only followed with TSH and free T4. It's so important to follow the TPO — the antibody that diagnoses Hashimoto's — because that number can change depending on your lifestyle, telling you whether what you're doing is helping. We've seen individuals whose antibody values back into the normal range again because they're doing something to offset the volume. Hashimoto's is the most common cause of hypothyroidism, and if you're not looking for it, you're not going to find it.
Vague Symptoms and Three Connected Systems
Very often these processes start with vague — but real — symptoms that aren't screaming "look here": fatigue, dizziness, palpitations, brain fog, anxiety, temperature intolerance, exercise intolerance. Reading that list, it also sounds like perimenopause. It can look like so many things — just like headaches, how many things can cause them?
There are three pieces to the autoimmune response: the immune system, the autonomic nervous system, and the endocrine system. When one is dysregulated, the others tend to follow — it's like a three-legged stool. That's why it can be so hard to diagnose: it's not one system. In the current healthcare system, specialists live in silos, but this area is inclusive of several silos. Just as every provider needs to understand perimenopause and menopause, every provider needs to understand autoimmune diseases and their causes and symptoms.
How We Test
How do we evaluate autoimmunity? We start with basic markers. We've talked about ANA. We routinely test rheumatoid factor (the beginning of looking at rheumatoid arthritis), C-reactive protein, sed rate, and TPO and TG for the thyroid. Homocysteine is another inflammatory marker to add. We also look at supportive nutrients and labs: vitamin D, iron, B12, and ferritin, plus metabolic markers like insulin, A1C, and lipids.
We also have to evaluate the gut, which I almost believe is one of the primary components. Over 70% of our immune system is located in the gut, so anything we get exposed to matters. If your gut is in dysbiosis or is unstable, it opens the door to permeability — the inability to keep out things that shouldn't come in. Think of the door in your house: without good weather stripping, you leak air all the time. A good gut lining is that weather stripping. There are tests we can add later to look at the gut barrier. Food sensitivity testing is another piece — it's very common for people to have a healthy nutrition plan but find that some of the healthy foods they're eating are causing inflammation, dysbiosis, bloating, gas, or other issues.
Treatment Options
What do we do when there's an autoimmune process? Conventionally, steroids, immunosuppressants, and biologics are first line — they stop the inflammatory response and make you feel better quickly. The cons: they suppress the immune system without addressing the cause, can have side effects, and increase infection risk.
Then there's root-cause support, which is really what gets to the bottom of things: food strategies (pairing down, adding anti-inflammatory foods, looking at sensitivities, possibly elimination diets), gut support (supporting the integrity of the gut lining), and stress and nervous-system regulation. Sleep is key — we take for granted what sleep does for repair and regeneration, and it's about quality, not just getting six to ten hours. Movement matters too: when someone is in an autoimmune flare, that's not the time to go crazy hard — support yourself, keep moving, but find a level of intensity that helps you feel better. Movement modulates and helps improve the immune response.
For nutraceuticals: an optimized vitamin D level (the key word is optimized — almost everyone not on a supplement isn't optimized), omega-3, iron, a good methylated B12, and probiotics — making sure your nutrients are optimized and supported. Hormone optimization is another piece — thyroid, DHEA, and sex hormones when appropriate can reduce flares and improve quality of life, because optimizing your levels helps the engine run smoother and gives you a quicker, better immune response. Some newer, non-mainstream, off-label options include low-dose naltrexone and peptides like thymosin alpha, though many don't have the randomized human studies yet.
Very often treatment includes bits and pieces from each of those sections. Sometimes steroids and immune suppression are needed as a bridge through a flare — there's a place for all the treatments. It's completely individualized for each patient.
Reframing the Mindset
One thing we hear from patients is that it's hard because autoimmune disease isn't really considered curable. So we reframe it: you can't control the label, but you can control the load. Inflammation is what creates the flares and symptoms, and you have so much power over the load you put on your system every day — what you eat, drink, and expose yourself to. Fewer flares is the important thing. It's not that a person can't reverse autoimmune disease — some can, though we don't understand a lot of it — but we do know we can reduce the load and the flare-ups.
From an emotional standpoint, dealing with your health brings up a lot of feelings — "What did I do wrong? Why is this showing up for me?" There's grief in changing your mindset from what you thought things would look like. A lot of the changes revolve around decreasing the inflammation you take in: improving nutrition, changing your movement strategy, increasing sleep. Especially in younger patients, that can feel hard, because you have to be a little different from your peer group to protect yourself — maybe not going out to the bars, avoiding alcohol or smoky environments. That's a hard transition, so having support through counseling — a mental health specialist or your provider — is a great way to work through it.
Practical Next Steps
If your body is whispering, don't wait for it to be screaming before you start looking into things. Go into it knowing that knowledge is power. Don't blame yourself or beat yourself up — it happens, it's often unexplainable, but if you know your triggers, you can control them.
Before doing more, get clarity — work with your provider and dig in to find where to put your attention. The gut is a great place to start. Calm the nervous system. And replace before you restrict — make sure nutrients like vitamin D, B12, iron, and omega-3s are optimized. It always feels better to add something in than to restrict something out. On the gut side, we like to remove common inflammatory triggers — more of a "GADS" elimination approach, avoiding gluten, alcohol, dairy, and processed sugars and starches. A reframe: focusing on adding the extra protein and fiber you need can create that elimination without feeling like you're restricting — a trade-off.
Track your patterns and understand your body. When you notice you're not feeling well, think about what you ate, your activity, and how much sleep you've been getting. Paying attention to patterns helps you connect the dots.
Reframe the goal as stability, not necessarily a cure — that's great if it happens, but the goal is fewer or shorter flare-ups, better energy between them, and confidence that you know what to do when symptoms show up. That's where you'll feel better.
Finally, build your team. Find people who will support you, listen, and work through it in partnership. It may take some legwork to find providers who will actually help, and you may need to create your own community — on Facebook, at your church, or in other social spaces — where you have connections to talk and find answers.
Thanks so much for tuning in. If you feel like we missed anything or there's something you want to dig deeper into, reach out and let us know — we're here for you. Have a healthy day.