As stated in our RULES: If these four rules are NOT solved, you may NEVER experience the relief you seek!
How do you know if a patient is autoimmune?
Are there some clinical ‘hints’ that should tip the practitioner or signs that should make a person question? I’ve listed a few signals that, if you notice you fit into one or more of these, it may be a good idea to get some testing done:
- You already suffer from a known autoimmune disorder (RA, psoriasis, ulcerative colitis, Type 1 diabetes, Sjorgen’s syndrome, scleroderma, sarcoidosis, lupus, Hashimotos….you get the picture). If you already have another autoimmune disease, the chances are higher that current symptoms in a seemingly unrelated area may be from an attack to that tissue as well.
- Your symptoms wax and wane. This is classic with autoimmune disease. Remember, it is when the immune attack occurs that you usually feel the worse so when your Th1 or Th2 system is ‘ramped up’, the inflammation is highest and your symptoms worsen. As time passes, your immune system may fatigue and ironically, when your immune system is completely ‘pooped out’ is when you feel better, you think that you may be on the road to recovery only to be knocked back down once your body has rested and gotten ‘back to the fight’.
- You take a boatload of supplements. I’ve had patients bring in bags of supplements that they’ve tried, are trying, or read about and plan to start. Usually autoimmune patients are desperate, they are searching, have not received much support or have run into a salesman who peddled them stuff they just don’t need. There is a serious danger here as well. Remember that certain supplements stimulate a Th1 response and others stimulate a Th2 response. If you are Th1 dominant and you are taking Th1 stimulants, you are feeding the fire! You may as well drink poison!
- Life fell apart for you after ___________. This is a very common finding in the history of the case; events in life ramp the immune system and can cause it to recognize a latent antigen that has lain dormant for years. I liken it to your home in a quite neighborhood. You like your neighbors and never noticed anything wrong or unusual until the day that the city doubled the police force and added security for the upcoming political event next month. When you came home from work there were four police cars next door and they were hauling thugs out in handcuffs from the crack house no one knew was there. Events in life, whether emotional, physical or spiritual, can cause a rise in the immune response, an increase in security that may flush out things lodged in tissues for years. Well, if this added security recognizes an antigen that isn’t alive and won’t die, the immune response is ‘turned on’ and the autoimmune disease is set in motion.
- Following pregnancy. A pregnant woman normally will be Th2 dominant in her third trimester and then Th1 dominant post partum. I often hear comments like, “I always felt best being pregnant, if I could only stay in a pregnant state, my life would be great;” or, “I love my kids but pregnancy just killed me, it was the worst I ever felt.” The one who felt great during pregnancy was the autoimmune patient who was Th1 dominant. When in the third trimester their body swung to Th2 dominant, it was a temporary balancing that dramatically improved symptoms and they felt great. Usually this same patient suffered post partum depression due to the violent swing in the other direction after giving birth. The opposite was true for the mother who hated being pregnant. She was Th2 dominant already and the Th2 swing in the third trimester just made her worse; boy was she a happy momma once the baby came and she just couldn’t figure out why those other moms struggled with depression and exhaustion.
- Positive testing via immune panels. (see below) Ultimately you want to get tested.
Autoimmune testing. The typical testing for autoimmune diagnosis is antibody testing. If Hashimoto’s is suspected, protocol dictates we run TPO antibodies and if positive, it would be a definite confirmation of our diagnosis. The only problem with antibody testing is that if a patient is Th1 dominant, they will be suppressing the Th2 system that makes the antibodies. Many patients that truly are autoimmune patients have negative antibody tests due to Th1 dominance and the diagnosis is missed! A more accurate testing is Cytokine tests. These will prove an autoimmune reaction AND show which side is dominant!
This is why we do NOT rely solely on standard blood antibody tests. A more unique approach is often needed and there are specific, quality functional labs that will pinpoint difficult cases.
Antigen Testing. There are many sources for testing antigens. Again, standard blood tests will only reveal what is circulating in the blood at the time of the draw so they tend to be unreliable. Hair analysis for heavy metals is somewhat reliable but samples must be done correctly without coloring, harsh shampoos and other hair products, etc.
A technique called Applied Kinesiology is most reliable and one we use for screening toxins, but it necessitates a professional with a lot of experience in the art – something I’ve studied, practiced, and taught for 30 years.
We also utilize specialty labs that measure specific functional lab values. Enterolab is a laboratory that created the most a very reliable analysis for several food-based toxins and genetic testing for such – it is a stool test. We will often run the Cyrex test for gluten, soy, casein, egg, and yeast on a patient with a suspected autoimmune disorder. We run a Stool Microbial Ecology Profile as well. This test, by Genova/Metametrix Labs, will reveal intestinal parasites.
One of our favorite labs is Cyrex. They have a multitude of panels to choose from including an Intestinal Antigenic Permeability Screen (Actomyosin IgA, Occludin/Zonulin IgG, Occludin/Zonulin IgA, Occludin/Zonulin IgM, Lipopolysaccharides (LPS) IgG, Lipopolysaccharides (LPS) IgA, Lipopolysaccharides (LPS) IgM), Wheat/Gluten Proteome Reactivity & Autoimmunity measuring over 24 possible antigens, Gluten-Associated Cross-Reactive Foods and Foods Sensitivity measuring dozens of cross-reacting antigens, and many more unique, specific tests.
III. Complete Blood Panels
We may need a Complete Metabolic Panel, a Lipid panel, a Thyroid panel (TSH, free T3, Free T4, and Total T3), a CBC with auto differential, C-reactive protein, homocysteine, TIBC, and 25-OH Vitamin D as well as 1, 25-OH Vitamin D levels. We recommend that you run the TPO and TGB antibodies or other antibodies specific to the area of attack even though they may not be positive if the patient is Th1 dominant.
The main priorities when looking at the blood work are:
- Autoimmune diagnosis, antigen detection and immune system dominance
- Anemias present: Iron, B12, Vitamin D, Pernicious, and Folic Acid
- Blood sugar/Insulin balance within functional ranges
- Adrenal function and hypothalamus-pituitary axis health
- Liver congestion, and health of detoxification pathways
- Gastrointestinal tract health, Leaky Gut, Metabolic Toxic Bowel, Probiotic health, Stomach health, Hypochlorhydria, H Pylori infections, ulcerations
- Cell membrane health, Bio-Impedance testing, fatty acid metabolism
- Thyroid health – complete thyroid panels
- Inflammatory states, possible cancer markers, toxicities
- Other pathologies, genetic markers, genetic predominance
Adrenal Stress Index (ASI) from www.diagnostechs.com:
We run this test on everyone simply due to the fact that stress is ubiquitous in this country. If there is any chronic fatigue, brain imbalances, hormone issues, blood sugar problems, etc., adrenal fluctuations may be evident. The ASI measures cortisol output throughout the day.
Immune Dysregulation: Th1/Th2 out of balance
Th1 and Th2 à which is dominant?
Th1 Dom = high IL-2, IL-12, NKC and TNF-alpha
Th1 is T-cells. T-cells are the police force that attacks and cleans up afterward. (Helper T-cells, Suppressor T-cells, NKC, regulatory T-cells, and macrophages).
Th2 Dom = high IL-4, IL-13 and IL-10
Th2 is B-cells. B-cells make anti-bodies. They tell T-cells what to kill. If the testing comes back with a high B-cell count, the patient is Th2 dominant.
Active antigens are BIOtoxins à parasites, bacteria, virus, mold, yeast, fungi, or protozoan à that your body is trying to KILL right NOW, NOT an autoimmune response to them; this is a BIG DIFFERENCE. If your immune system is simply killing an Antigen, then aid the high immune pattern (if high Th1, help increase it). BUT, if it is autoimmune toxicity, then treat as an autoimmune condition, NOT a normal physiologic response!!!!
The best indicator for an active antigen as the cause of the patient’s abnormal dominance is the “Helper/Suppressor” ratio on the T & B cell panel. (Also called “CD4:CD8” ratio).
The closer to 2.5 the ratio is (or if above that), the more likely it is that you’re dealing with an Active Antigen. If the ratio is below 1.2, then you are most likely dealing with a dys-regulation problem.
If ACTIVE ANTIGEN = treat accordingly!!
To test for active antigens use the following tests:
1) Metametrix.com = Stool Microbial Ecology Profile #2105
2) Enterolab.com for food antigens
3) Urea/H.Pylori breathe test from Metsol.com
Intestinal Permeability from www.genovadiagnostics.com:
LGS or Leaky gut syndrome describes a condition of altered or damaged bowel lining, caused by antibiotics, toxins, poor diet, parasites or infection can lead to increased permeability of the gut wall to toxins, microbes, undigested food, waste or larger than normal macromolecules. It has been proposed that these substances affect the body directly, while others postulate an immune reaction to these substances.
VII. HORMONE PANELS (we use the DUTCH panel):
We can check hormone panels to determine if the patient suffers from low testosterone in males or low/hi estrogen/progesterone levels in females. Symptoms related to decreased hormone levels may include depression, fatigue, mental fogginess, mood swings, hot flashes, sweating attacks, weight gain, and decreased physical stamina. We ONLY run what are called Expanded Panels. These are panels that take a ‘movie’ over an entire cycle for the female. It does little good to see a snapshot of hormonal activity; we need the entire cycle to measure fluctuations.
VIII. Urea / H. Pylori from www.metsol.com:
We run the only reliable test for H. Pylori bacteria to determine any problems related to the gut function. This is a breathe test, not a blood test.
Homocysteine and C-reactive protein:
Testing for inflammation. Tested through LabCorp or your local lab.
We cannot overemphasize the importance of homocysteine and C-reactive protein testing. Homocysteine levels are toxic in functionally high concentrations and responsible for the etching of the arteriole walls that lead to atherosclerosis. C-reactive protein is a measurement of inflammation in the body and may be the first indicator of an autoimmune response.
Understanding Thyroid Markers and Panels
TSH: Thyroid Stimulating Hormone (TSH) is also called thyrotropin. The pituitary releases this hormone after the hypothalamus releases TRH (thyrotropin-releasing-hormone). This is the most common marker used to assess thyroid function and it is also the most sensitive. The TSH levels increase when the T4 levels drop, and the TSH falls when T4 levels increase. This is the only test performed in the traditional health care model as a means to screen the patient for thyroid disorders; this is because they are only concerned for screening the thyroid for hormone replacement and not optimal physiological function. A TSH test alone does not consider thyroid-pituitary feedback loops, peripheral thyroid metabolism, or potential or active risk factors as identified by antibody testing. A high TSH with or without changes in T4 or T3 is diagnostic to determine hypothyroidism. If the thyroid is not making enough T4 the pituitary will pump out TSH to stimulate its production. A low TSH is used to determine hyperthyroid activity. If the thyroid is overactive, such as in Grave’s disease, the antibodies bind to active thyrotropin (TSH) receptors on the thyroid cells and stimulate T4 production without the influence of TSH. Please note that some antibodies may inhibit thyroid function by inactivating instead of stimulating thyrotropin receptors. This is called an autoimmune hypothyroid. These patterns will demonstrate a hypothyroid pattern (elevated TSH) with elevated thyroid antibodies.
Laboratory Reference Range: 0.5 – 5.5 (varies from one lab to another)
Functional or Optimal Reference Range: 1.5 – 3.5
Total Thyroxine (TT4): The TT4 test measures both bound and unbound Thyroxine levels. Therefore, it does not give the activity of T4 when measured alone. This test is best completed with a T3 uptake. The free Thyroxine index (FT4) can be calculated by using the T3 uptake and demonstrate a level of T4 activity. Total T4 levels can be altered by many drugs (see Category of drugs that interfere with thyroid activity).
Functional Reference Range: 6-12 ug/d
Free Thyroxine Index: As stated earlier, the total Thyroxine and the T3 uptake must be used together to calculate the FT4. The index is measured by multiplying the TT4 levels by the T3 uptake levels. The result is the FT4 and it determines the amount of active T4 available. The impact of drugs, as will be discussed, will always impact T4 and resin T3 uptake levels in opposite directions due to their impact on binding sites. If the TT4 level is depressed, then the T3 uptake is high; if the TT4 is elevated, the resin uptake is low. Please note that even if you are taking drugs that may impact thyroid binding, the free Thyroxine index should be within the normal range if your thyroid is functioning normally.
Functional Reference Range: 1.2 -4.9 ml/dl
Free Thyroxine (FT4): The free Thyroxine test is used to measure the amount of free or active T4 in the blood. All the factors such as drugs and physical conditions that may impact the TT4 do not impact the FT4. The level of T4 in the blood is high with hyperthyroidism or low with hypothyroidism. Please note that even a TSH with normal T4 is enough to diagnose hypothyroidism. A rare pattern is an elevated T4 without hyperthyroidism which may be related to a hereditary condition of thyroid resistance. Elevated free T4 may also be caused by patients taking heparin or by an acute illness that may briefly cause the binding protein levels to suddenly fall. If an illness becomes severe and chronic it may decrease the FT4 levels but it is not a thyroid disease.
Functional Reference Range: 1.0 -1.5 ng/dL
Resin T3 Uptake: The resin T3 uptake measures the amount of sites for active (unbound) T3 to bind with Thyroxine binding proteins. This test is performed by mixing the blood with radioactive thyroid hormones. These radioactive hormones then combine with binding sites on Thyroxine-binding proteins. The blood is then exposed to a substance called a resin which will bind the unbound thyroid hormones and measure for radioactivity. The result can be expressed as the percent of radioactivity found on the resin, compared to the original radioactivity that was added. The more binding sites that are open on the proteins, the lower the resin uptake result will be, and vice versa. For example, anything that reduces the binding sites, such as elevated testosterone or testosterone replacement therapy, can cause a low T4 measurement because it leaves very few binding sites for any thyroid hormone to bind to. If T3 is added to the sample of the blood, little T3 will be bound. This pattern would have low TT4 levels and high resin T3 uptake levels. On the other hand, anything that raises the binding sites such as estrogen or birth control pills would cause a pattern of high TT4 and low T3 uptake.
Functional Reference Range: 28-38 mg/dl
Free Triiodothyronine (FT3): This test measures the free T3 hormone levels. This test is rarely completed in traditional endocrinology. It is typically only used in a situation when a patient has hyperthyroid, yet the FT4 levels are normal. However, the FT3 test is the best marker for measuring the amount of active thyroid hormones available for the thyroid receptor sites.
Functional Reference Range: 300-400 pg/ml
Reverse T3 (rT3): This test measures the amount of reverse T3 that is produced. The production of rT3 typically takes place in cases of extreme stress, such as major trauma, surgery or severe chronic stress. It appears that the increased production of reverse T3 is due to an inability to clear rT3m as well as from elevated cortisol.
Functional Reference Range: 90-350 pg/ml
Thyroid Antibodies: Thyroid auto-antibodies indicate that the body’s immune system is attacking itself. Production of thyroid auto-antibodies may create a hypothyroid or a hyperthyroid state. Some antibodies attach to the TSH receptors but do not cause a response; therefore, the patient will complain of low thyroid symptoms. However, the serum TSH may not be altered. It is just not able to cause a cellular change. On the other hand, some antibodies will bind to the receptor sites and cause over activation of the thyroid. This will present as elevated T4 levels, a low TSH, and elevated thyroid antibodies.
Simply contact our office for more information – 651-739-1248.