In humans you’re probably familiar with the most common autoimmune diseases, like rheumatoid arthritis, lupus, MS, IBS, type 1 diabetes, hypothyroidism, psoriasis, Crohn’s disease, colitis … the list goes on, and there are many more autoimmune diseases that affect the nervous system, joints and muscles, skin, endocrine glands, and heart.

And all due to an overactive immune system attacking parts of its own body that it misidentifies as foreign, causing what’s known as an autoimmune disorder.

Yes it’s Functional Medicine podcast time again, and this week I've been following a training module on the latest strategies to reverse autoimmune disease, and with one heck of a (human) case study in there as well, which I really wanted to share in a Blog so you could see how this could so easily translate to our horses, and ultimately how we can put a programme in place to get our horses better when nothing’s worked previously.

In our horses, autoimmune disease is not so well identified but there are some clear examples and markers, i.e. if an antigen enters through the skin or mucous membranes, typically we’ll see a localised reaction such as unexpected itchy skin, sweet itch, or hives (urticaria). Then there’s equine asthma, sometimes called ‘heaves’, thought to occur due to an allergic reaction caused by long-term exposure to allergens such as pollens, mould, or dusty forage, and often connected with poor ventilation.  

We can also see syndromes along the lines of muscle disorders, repeated episodes of pneumonia and/or infections, and recurrent abscesses.

So let’s talk about the main causes of autoimmune disease, the conventional medicine approach versus the Functional Medicine (FM) approach, and what you can do to help reverse the course of these devastating illnesses.

So, staying with us humans, how many of us have allergy responses? Are there gluten sensitivities that might be confusing your immune systems? Or could there be toxins like heavy metals or pesticides? What about diet (now there’s my favourite subject 😉). And how are we dealing with stressors?

Apart from the gluten, these same allergies could equally relate to our horses, so if you or your horse has an autoimmune syndrome, this blog is for you. We’re going to look at why there’s so much autoimmune disease, what the real causes are, and how to deal with them other than taking eye-wateringly expensive medication that can also have significant side effects. So, let’s get into it.
 
Staying with human numbers, autoimmune diseases affect around 10% of the global population, with 13% of women and 7% of men said to be affected, and with around 10% of the UK population being affected. If we combine all the autoimmune diseases together, it’s apparently more than those who have cancer, heart disease, or diabetes put together. Which is huge. So how come we don’t hear about it? Because … every separate medical specialty has their own autoimmune disease to look after, and each department keeps it to themselves.

For example, you’ve got the neurologist who looks after MS, and the gastroenterologist who’s got colitis. The endocrinologist looks after Grave’s disease or Hashimoto’s, the rheumatologist has rheumatoid arthritis and the dermatologist’s got psoriasis. And so it goes on; essentially every specialist is ‘siloed’ - an attitude where departments or teams don't share knowledge or collaborate with one another, leading to difficulties in achieving long-term goals. Or in this case, autoimmune disease recovery.

Unlike what we may think, autoimmune disease is not a bunch of different diseases - it may affect us all differently, but there are common principles that address the root causes and get the body healthy again. The frustration is that they’re a consequence of our modern western lifestyle – you simply don’t see this in countries that follow a more traditional way of living, people who still live the way that they’ve always done. No wifi, no pressure, just the simple life living naturally like a shepherd or farmer - check out the Blue Zones on google then tell me you don’t dream of that life!. And guess what - they don’t get autoimmune disease, they don’t get allergies – nothing.

However, here in our Western society it’s all about allergies, asthma, skin disorders et al, so the question has to be, Why? Deep down we all know the answer but we rarely have time to think about it because it’s basically all due to how we live our lives, based on high-pressure lifestyle choices in our modern, western world.

Interestingly, just as infectious diseases went down back in the mid last century, the rates of people with autoimmune diseases went up, and yes there’s a huge connection here. These days we know what the causes are, even though most regular medical professionals don’t treat the cause, staying with symptom blockers to suppress the inflammation, which will make us feel better in the short term, but won’t actually deal with the problem. A bit like taking morphine with a broken ankle and being able to walk on it. It’ll work, but it’s really not the best plan 😉.

It’s not that medications are all bad, but by not addressing the root cause may present more serious consequences such as eventual joint destruction or kidney failure. There is a better way.

We’ll get to the case study, which clearly emphasises the message behind the long-term implications; in this case of a young girl, just 10-years old, who suffered from one of the worst autoimmune conditions seen. And it really really begs the question that if even one case could get better using a different approach than our traditional thinking, shouldn’t our goverment be spending money studying this?

Thing is, it’s unlikely to ever happen because the solution isn’t a pharma drug, and no surprise, one of the biggest profit centres for many of the pharma companies are, you’ve guessed it - autoimmune drugs. We’re looking at around £50k per person per year for these autoimmune meds, so that’s a huge chunk of profit that Big Pharma understandably won’t want to let go of.

What is autoimmunity?

Let’s take a step back and look at what autoimmunity is; what causes it and why should we be so concerned? We know it’s when the immune system is out of control and creates systemic inflammation, and depending on genetics and other various issues there may be, it can also attack different parts of the body. Essentially though, the process is the same as when the body creates antibodies which are normally designed to fight infection, even to kill cancer. It all goes wrong with autoimmunity because these antibodies then do a 180 and attack the body’s own tissues, so basically we have a very confused immune system which creates an ever-increasing runaway inflammation.

The immune system is supposed to step up when we have foreign invaders like an infection, or when we have cancer to kill the cancer, or creating antibodies to varying food sensitivities which can lead to – and here’s a huge connection to our horses - a leaky gut. Our immune system is meant to be our first line of defence, but when it gets muddled, it causes widespread destruction in the body, with the cells, tissues and organs getting caught in the crossfire. What we’re seeing now is an immune disease epidemic that’s being completely misunderstood. 

Somewhat worrying, these days in FM world there’s now a trend showing what’s loosely being termed as ‘pre-autoimmune disease’. Around 30% of the people that the FM medics see – and we’re not even talking really sick people; we’re talking regular young people, all reasonably healthy yet whose lab tests are already showing elevated levels of an anti-nuclear antibody, which is an early sign of autoimmune disease. This is alarming for sure, so the question is, why is the body doing this?

A case study

And a quick reminder that how it currently happens is that we’ll get lab tests which concur with the presenting symptoms, and the system stops there. The results are given a named disease, as in “You’ve got X,” so we’ve then got a disease name to blame.

Now meet Isabel, a 10yo girl who had a severe autoimmune disease ‘label’ called dermatomyositis. If you google it you’ll see it’s an “uncommon inflammatory disease marked by muscle weakness and a distinctive skin rash. The cause of dermatomyositis is unknown. Experts think it may be due to a viral infection of the muscles or a problem with the body's immune system. It may also occur in people who have cancer in the abdomen, lung, or other parts of the body. Anyone can develop this condition.”

Dermatomyositis is nobody’s best friend. Essentially it’s one of the worst autoimmune diseases a human can have. Everything - joints, skin, liver, blood vessels, muscles - gets affected so we’re talking widespread destruction throughout the body. Unfortunately, what Isabel’s previous doctors didn’t say was, “Wow, why is her immune system so p***ed off?” Instead, they gave her a pile of drugs including steroids and – wait for it - cancer drugs to suppress her immune system.

They were then about to put her on an antagonist immune blocker, to basically block the inflammation marker in the blood that’s responsible for a lot of autoimmune diseases, which (fair play) can be helpful. But still, nobody was asking the very simple question as to why she was so inflamed in the first place. By this time her mother had had enough and found a FM doctor. So here’s what he said (quoted directly from the Podcast – yes, that’s me audio typing again 😉):

“Now, as I mentioned, Isabel had one of the most severe cases of autoimmune disease I’d ever seen. At 10 years old, she had severe skin rashes. That’s the dermatitis. ‘Itis’ means inflammation. She had every kind of itis. She had vasculitis, which is inflammation of your blood vessels, causing ray nodes. She had gastritis causing inflammation of her oesophageal tract and causing terrible reflux. She had hepatitis affecting her liver. She had inflammation of her blood cells. I don’t even know what to call that, but she had low white count and low red cells. She had severe muscle damage, so she had myositis and very severely elevated muscle enzymes. She had also severe arthritis and joint swelling. So basically everything was under attack. 

Now, this cute little girl, just 10 years old, she loved riding horses. But she couldn’t do the most basic things anymore. She couldn’t squeeze her hand or make a fist. Her tips of her fingers and her toes were totally numb all the time from Raynauds disease, which is the damaged blood vessels’ autoimmune condition. She had rashes all over her body that were irritated. She was exhausted. She felt miserable. Her hair was falling out, and she was being treated by doctors who were doing the best they could, but were using the old theory. They were saying, okay, well she’s got inflammation so let’s get that under control, so they give her a huge dose of steroids, Solumedrol (a corticosteroid hormone – we know it as Prednisolone) at essentially a horse dose of 1200mg intravenously, and intravenous steroids every three weeks just so she could sort of be able to function. 

She was also on Methotrexate, which is a chemo drug to depress immunity. Also Aspirin to thin her blood because the inflammation caused her blood to clot. She was on acid blockers because of the reflux from her stomach. She was on calcium channel blockers to help open up her blood vessels because of her ray nodes, I mean literally, she was on more drugs than you see 80-year olds and beyond on.

And despite these mega doses of medications, she wasn’t better. I mean, she was managed, you call it managing her disease, yet her labs were all abnormal. Her skin was still inflamed, her joints were shot. She should have been in hospital basically. And her doctors wanted to add another drug called the TNF alpha blocker. Basically this drug can be helpful if you don’t have anything else to fix the problem and turn off the inflammation, but it increases the risk of cancer and also infections because it suppresses the immune system. So that’s a problem.

So I asked some questions. I didn’t ask “What’s the inflammation”, but “What’s the cause?” Not what’s the name of her disease, but what’s the cause of her disease? What’s making her immune system so sick? I always say FM is the medicine of ‘why’ medicine, conventional medicine is more the medicine of ‘what disease do you have and what drug do I give’? Never ‘why’. Just because you know the name of your disease, it doesn’t always mean that’s what’s wrong with you. And here, just because the name of Isobel’s disease is dermatomyositis, it doesn’t mean we know what’s wrong or what’s causing it. Dermatomyositis just means skin and muscle inflammation. Those are the two most prominent symptoms. It doesn’t mean anything. It’s just a fancy medical word describing the symptoms. So FM gives us a map to help understand why.

So when we look at the causes, how do we start to think about causes systematically? How do we have a organised approach to diagnosis about what is causing the body to react to something? What we do know is that the body’s not really attacking itself on purpose. It’s trying to do the job that it’s supposed to do, which is fight bad things, right? Allergens, bugs, microbes, and mostly imbalances in your gut or your microbiome. We’ll get to that.

Toxins and also stress and poor diet also drive inflammation, psychological stress, physical stresses. But basically there are just five causes of almost all disease allergens. And that can be a food sensitivity, it can be a true allergen like peanut allergy, it can be microbes, it can be something like Lyme disease or hepatitis, plus it can be just dysbiosis imbalances in the gut. It can be toxins, petrochemical toxins, environmental toxins from pesticides, herbicides, plastics, as well as heavy metal toxins, flame retardants. I mean the list goes on and on down the road.

In fact, there’s a whole school of research now on environmental toxins that trigger an autoimmune response, so all these factors need to be investigated. We need to look at each person and say, do they have any allergy stuff? Is there gluten sensitivity? Are they harbouring latent infections that might be confusing their immune system? Or do they have a toxin like heavy metals or pesticides? What’s their diet - are they eating an inflammatory diet? How much stress do they have? All these things need to be considered and need to be investigated, so you can figure out the cause. If you want to fix autoimmune disease, you got to get to the cause. And unfortunately in medicine, we don’t do a good job at that. We get a little bit of it right, but not much, right?

I’d never seen a case of dermatomyositis in my life other than in traditional medicine care when I was in residency and early practice. But as a FM doctor I knew exactly what to do because I followed the FM methodology to provide the fundamentally different way of solving medical problems, getting to the root of the illness and understanding the disturbances that really are going on.

So let’s talk about Isabel a little bit more. She was seeing good doctors and their response was “let’s shut down this kid’s immune system”. Let’s just throw the whole kitchen sink, the whole barn, everything, at it. She might’ve had improvements in her symptoms, but she would’ve been a high risk for cancer, infection, osteoporosis, muscle issues, weight issues, psychiatric illnesses. And by the way, it would’ve cost a huge amount of money forever, right? This is a 10-year old girl. She’s going to be on drugs that costs £50-grand a year for the next 60 years. And that’s just one person. Not acceptable.

So I started with simple questions with Isabel, not focusing on the name of her disease. I wanted to know why her inflammation started, how we could find the root causes and how we get to restore balance in her immune system. So some insults usually are triggering some confusion. We call it molecular mimicry. There’s a theory of immunity called molecular mimicry that, for example, some food you’re eating or gluten somehow confuses your immune system and it thinks your thyroid is some foreign object, but it’s just reacting with the gluten antibodies, and that’s why you end up with autoimmune disease.

So I was looking for toxins or looking for allergens or for bugs for dysbiosis. And by the way, a lot of autoimmune disease starts in the gut, and a lot of it starts with leaky gut, which clearly she had. So when I did her history, she had exposure to severe toxic mould in her house. And her mother also worked in limestone pits when she was pregnant, and she was exposed to a lot of toxins and fluoride, heavy metals. And she also had her immunisations before 1999 and before this, Thimerasol hadn’t been removed from childhood vaccines, so they were getting mercury in the vaccines until they said, ohoh wait a minute (it’s since been removed from child immunisations). So that’s a lot of mercury that we’re never going to get out. And if you’re also getting multi-dose flu shots you get Thimerasol, and she was getting flu shots every year.

And she also loved to eat sushi which she ate regularly, adding more mercury. She also had a diet that was very high in sugar, with lots of dairy. She also had many infections during her life, ear infections, sore throats, because remember she was on a lot of immunosuppressive drugs as well as the steroids which also cause problems. And she had lots of antibiotics, so that’s real damage to the gut. So mould, mercury, antibiotics, sugar, dairy, gluten, junk food, all were potential irritants.

So then I looked at her conventional lab tests pretty carefully, and there were high levels of CPK muscle enzymes. Her liver function tests were off the chart. She had many autoimmune antibodies that were not just slightly high, they were off the chart high, like the highest I’ve ever seen. Anti-nuclear antibodies, rheumatoid factor antibodies, anti-double stranded DNA, anti-RNP antibodies, lupus anticoagulant, a lot of big mumbo jumbo medical terms. But basically the whole soup of autoimmune antibodies were just off the chart with her. And by the way, most autoimmune specialists do not check antibodies after the initial check because they don’t ever go back to normal because they don’t get rid of the cause. And we saw that with Isabel.

So she had a lot of other problems, lots of elevations in other markers of inflammation, her white count was really low, her red cells were low, her vitamin D was severely low. She had really high antibodies to gluten, which by the way is a common cause of autoimmune disease, probably the most common and can trigger a significant inflammation and leaky gut, her mercury level was off the chart at level 33. Normal is less than 3, so it was very high.

That first visit I simply didn’t do too much. I just put her on an anti-inflammatory elimination diet, so no gluten, no dairy, no sugar, no processed foods, to get rid of the most common allergens. I gave her a multivitamin. I got her on vitamin D. I gave her some B12 and folate because of the acid blockers, and anti-inflammatory evening primrose oil. So I kind of gave her some basic nutritional support and I also gave her an antifungal to treat yeast overgrowth in her gut which I suspect that she had due to the multiple courses of antibiotics. Also liver support with N Acetyl Cysteine to boost her glutathione.

And I told her parents probably over time, she’d be fine, and meanwhile to come back two months later. Have to say I didn’t know what to expect because there was still the acid blocker, the calcium channel blocker and the steroids to wean out.

So she came back and she said her symptoms were completely gone. Her rash was gone, her joint pain was gone, her hair was growing back, her muscles weren’t hurting. Her autoimmune markers were much, much better. Her muscle enzymes, her liver function, her C-reactive protein, all normal. Now this is just two months. Then I added probiotics to help her digestive system heal a little bit and reduce the gut inflammation, and got her on an accumulating drug called DMFA to combine the metals from her tissues and help get off the Prednisolone.

I also gave her some herbs to help her adrenal glands to counter all those steroids and she tapered those down. A few months later, everything was normal. All of her lab tests were normal, including her white count, her liver function, her muscle enzymes, the autoimmune antibodies, you never see that, right? Her mercury came down from 33 to 16. After 11 months, her mercury was down to 11. Her gut inflammation was gone. 

After a year, she was off all her medications. Her labs were normal. She felt great. She was able to ride horses again, and she was just so excited. I checked in with her many years later and she was still doing great, she was still fine. We fixed the problem.”

To conclude

So there we have it. Get rid of the cause, fortify the diet, and stuff won’t come back - simples. And you probably won’t be surprised to hear that Isabel’s case isn’t rare, which makes it all the more important that there really should be a major effort from the government to fund research along these lines, but currently everyone’s stuck in their silos, practicing their own specialties and keeping it all unconnected. Our medical system still isn’t looking at the body as a whole system, despite cures like Isabel’s being achievable.

And so to the simple, yet so important, steps to think about to reverse autoimmune disease, and it really couldn’t be easier. And this is where we can translate it to our horses who are day-in day-out fed the same C.R.A.P. diet (Carbs, refined, artificial and processed) from shiny bags, turned out on the same small, spoilt, acidic paddock each day, fed haylage, given annual jabs and toxic wormers, and often stabled in winter alongside damp and stable moulds etc etc.

1. Alleviate. There's going to be pain, and it's very likely there's going to be stress, so these need alleviating.
2. Detox and eliminate. We’ve got to get rid of the bad stuff, and you have to find it all. In Isabel’s case it was mould, mercury and heavy metals, with yeast in her gut alongside a processed-food diet and gluten. When it comes to our horses there are other factors - parasites and Lyme disease has been linked to autoimmune disease. You really need to think outside the box and get your detective hat on - check for environmental chemicals, i.e. crop-spraying, but what’s really important is to fix that leaky gut and get rid of the toxins, bad bacteria and parasites circulating in the bloodstream.
3. Fortify. Now add in good stuff for good health - whole foods and nutrients. Eliminate pro-inflammatory gut-damaging processed, refined, artificial foods, and fortify the diet with prebiotics and nutrients for gut lining healing. Vitamin D is essential for autoimmune disease prevention; it’s apparently well known that there are low levels of vitamin D in MS sufferers, so vitamin D (for our horses that means rugs off for skin exposure), omega-3 oil (micronized linseed for our horses), vitamin C (our horses produce this via the liver), prebiotics - see our Gut System page, and there’s a wonderful selection of anti-inflammatory herbs to take, curcumin for one.
    
   

For us humans who have an autoimmune disease, I really encourage you to find a FM doctor and work with them. Get your labs done to see if you have pre-autoimmune disease, hidden infections or other markers. Of course a horse can’t do this so we have to think outside the box, but when I say hidden infections, we’re talking our old friend, dysbiosis - imbalances in the gut flora and where, lest we forget, at least 70% of our horse’s immune cells are created and housed. Interestingly, vets actually call leaky gut an ‘infection in the gut’ then prescribe antibiotics. Hmm …

I’ll end with a final thought, and that’s to always question the traditional view of autoimmune disease as it's so important to connect all the dots. You won't be surprised to know how many client enquiries I get from desperately worried owners whose insurance is maxed out and nothing's worked for years and years.

If we take ownership by digging deep and figure out the cause, then the rest is straightforward - it's all about following follow the Alleviate, Detox and Fortify protocol.

"The only way to fix your horse is to help them return to their natural state."

Juliet Getty, Getty Nutrition

As always, just a reminder that this blog is for educational purposes only, and opinions are my own. It’s not a substitute for professional care by a qualified medical professional.