Saturday, May 24, 2014

What's Hiding Behind the Mask of Lupus?

It often seems like lupus is a disease bent on deception. It can evade diagnosis with symptoms that mimic or overlap those of other health conditions. And there is no one test that diagnoses it definitively. But despite its complex, even duplicitous characteristics, lupus, once properly diagnosed, can often be treated successfully with an integrative approach that addresses the underlying causes of the disease.
What Is Lupus?
To understand what treatments may be effective against lupus, it's important to first understand the disease itself. Lupus is a chronic autoimmune disease that creates systemic inflammation throughout multiple body systems. An autoimmune disease is one in which the body's immune system turns on its own tissues. Rather than fighting something that's actually hostile to your body, such as a virus, an autoimmune disease causes your body to start fighting a part of your body, like your joints, brain or kidneys.
Lupus alone can attack a person's joints, skin, kidneys, blood cells, heart, lungs and brain, creating disabling and sometimes deadly reactions. The most common form of lupus is known as systemic lupus erythematosus (SLE). However, there are rarer versions of the disease: discoid lupus erythematosus (DLE), subacute cutaneous lupus erythematosus (SCLE), drug-induced lupus and neonatal lupus.
The symptoms of lupus can vary and can mimic other conditions. No two patients will experience the disease exactly the same. However, the most frequent symptoms include:
  • Malar rash
  • Sun sensitivity, often leading to a rash or skin lesions
  • Fatigue and fever
  • Arthritis-like joint pain, stiffness and swelling
  • Raynaud's phenomenon (fingers turning white then blue in response to cold or stress)
  • Dry eyes
  • Shortness of breath
  • Chest pain
  • Anemia
  •  Headaches
  •  Memory loss and confusion
  • Seizures

A malar rash, also known as a butterfly rash or the mask of lupus, is a telltale sign of lupus—although not everyone with the disease develops it. It's a rash that covers the cheeks and nose in a butterfly-like pattern. People with the discoid lupus develop red, raised disk-like patches on the body, not the face.

What Causes Lupus?
There are probably as many predisposing factors for lupus as there are people who develop it. Biochemical breakdown (not enough Acetyl Coenzyme A), hormonal imbalance (not enough cortisol), chronic infection, medication, nutritional deficiency, toxin overload, DNA dysfunction, etc. are all known to play a part in different people.
The causes of lupus are complex and varied, but everyone with lupus has three problems characteristic of anyone else who gets an autoimmune disease. These three problems converge to create a perfect storm: their illness. First, gene activity that creates a potential weakness in the body. Second, damage to the gut from medications, toxins, infections, foods, or stress. And third, exposure to an environmental insult: infection, food sensitivity, toxic metals, and/or other environmental chemicals.

People with lupus frequently have a family history of autoimmune disease; it doesn’t have to be that Mom had lupus. It may be a grandparent with Parkinson’s disease or a brother with psoriasis. Occasionally, one will be the first in their family. Around two dozen genes that contribute to lupus have been discovered. Lupus most commonly occurs in young African American, Hispanic and Asian women.
Second, once the gut is damaged (leaky gut or intestinal permeability disorder), the immune system gets ramped up generating chronic inflammation.  This inflammation doesn’t stay local. It spreads to other organs and distant parts of the body. And depending upon the insult and the person’s genetic weakness, they may develop lupus, Autism, rheumatoid arthritis, multiple sclerosis, Crohn’s disease, Hashimoto’s thyroiditis, or any one of almost 300 autoimmune diseases.
Lastly, environmental insults are everywhere. A few of the many sources of toxins include adjuvants in vaccines, cleaning products including Febreze® and other air fresheners, mercury from coal fired power plants and amalgam fillings in our mouths, and GMO foods and Roundup® and BT corn. Food sensitivities like gluten in wheat and casein in dairy products may be toxic. Infections from bacteria including Lyme, Chlamydia, and Mycoplasma. Viruses like mononucleosis, HHV 6, a herpes virus, parvovirus B19 and parasites cause autoimmune diseases. The damage from all of this is magnified by nutritional deficiencies from lack of adequate vitamins, minerals, antioxidants and essential fats.
The complications of lupus are serious. Kidney failure is one of the leading causes of death among people with lupus. However, other possible complications include:

  • Pericarditis (inflammation of the heart membrane)
  • Cardiovascular disease
  • Heart attack
  • Pleurisy (inflammation of the chest cavity lining)
  • Blood clotting
  • Vasculitis (inflammation of the blood vessels)
  • Anemia
  • Seizures
  • Stroke
  • Headaches
  • Vertigo
  • Behavioral changes
  • Memory problems
  • Infection vulnerability
  • Increased cancer risk
  • Bone tissue death
  • Pregnancy complications
Other Autoimmune Diseases
Before discussing potential treatments for lupus, let’s look at the entire spectrum of autoimmune disease. The incidence of these diseases has tripled in the last two decades. Over 24 million people have autoimmune disease. Most of them are women.

What’s driving this epidemic? Let’s look at the three underlying characteristics of all autoimmune disease. Genes don’t change fast enough to explain the explosion in autoimmune disease. But lack of nutrients and toxins or infection can turn on or off different segments of the genes, that’s called epigenetics. And that can change genetic expression very quickly. And really bad news ... those changes can even be inherited. 

What could be damaging the gut? GMO foods are known to damage the gut lining. Roundup damages our healthy gut bacteria which results in damage to the gut lining. Medications, stress, and foods can damage the gut lining causing leaky gut.

What about toxins? Over 90,000 chemicals have been released onto the planet since 1900.  Few have been tested for safety. Children are receiving increasing numbers of vaccines containing additives like aluminum, a recognized neurotoxin, and squalene which is thought to have contributed to Gulf War Syndrome. In 2004 determined that new borne babies had up to 300 industrial chemicals in their bodies. They had gotten these from their mothers before birth. The CDC found an average of 148 chemicals in 2000 Americans bodies in 2005. They didn’t test for as many as EWG.

Numerous physicians and scientists are convinced that the dramatic increase in illness in the past two decades is due to an overwhelming poisoning of our bodies by numerous toxins in combination with a nutritionally deficient diet. A great book is The Autoimmune Epidemic by Donna Jackson Nakazawa. She is an investigative journalist who struggled with autoimmune disease; this spurred her interest. Another older series of books about environmental illness is by Sherry Rogers MDDetoxify or Die, is good to start with. She was among the first physicians to develop autoimmune disease from toxins and write about it.

So treatment of all autoimmune diseases, including lupus, involves determining the exact causes and treating these causes. This may include removing toxins, enhancing nutritional status, balancing the immune system, balancing hormones, healing the gut, reducing stress, and eating healthy healing food.

Integrative Treatments Are Yielding Amazing Results
Traditionally, lupus has been treated one of two ways: (1) on a symptom-by-symptom basis, or (2) by aggressive disease control. The former can be problematic because it doesn't address the overall progression of the disease. And the latter, while more effective, includes the use of strong medications with numerous side effects. The drugs used to treat lupus range from common over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) like Aleve and Advil to antimalarial drugs, corticosteroids and immune suppressants.

Corticosteroids produce long-term side effects, including weight gain, high blood pressure, bone thinning and diabetes. Meanwhile, immune suppressants lead to increased infection risk, increased cancer risk, liver damage and decreased fertility. Sadly, none of these aggressive drugs address imbalances or reactions in the body that are contributing to lupus.

Dr. Mark Hyman, chairman of the Institute for Functional Medicine, describes these traditional treatment approaches as equivalent to "taking a lot of aspirin while you are standing on a tack." While established treatments shouldn't be ruled out (particularly in the short term), it's beneficial to explore other less harmful options that get at the root causes of the illness.

As with any health condition, integrative doctors take a whole-person approach to lupus treatment. This means looking at how a person's health status, lifestyle, nutrition and environment may be contributing to the disease, and what related treatments might be most beneficial. In some cases, integrative doctors have seen complete remission in lupus patients by applying the following strategies:

Hormone Adjustments:  Whatever the cause, adrenal insufficiency with reduced hormone production is frequently seen in lupus. Adrenal insufficiency (low cortisol) stimulates the pituitary gland to increase adrenocorticotropic hormone (ACTH) production which turns on production of cortisol by the adrenal glands. This is a normal feedback loop. But when the adrenal glands don’t respond MORE ACTH is produced and another hormone, melanocyte-stimulating hormone (MSH) is also made in excess. MSH causes the skin-related symptoms of lupus such as increased pigmentation and the mask of lupus. ACTH itself causes dark circles and/or bags beneath the eyes. A combination of supplements and hormone treatments can readjust the hormone levels. Hormone replacement may initially involve prednisone, with the goal of weaning the patient off of it and onto low-dose bio-identical hydrocortisone (cortisol) or supplements using licorice root or adrenal glandulars. In addition, high dose supplemental DHEA (200mg/day) is also effective in treating lupus. DHEA  reduced the number of lupus flare-ups and improved patient’s overall opinion of control of their illness.

Vitamin D3 Supplementation: Low levels of vitamin D3 are common in autoimmune diseases like lupus, and many studies have indicated that people with lupus who have low 25 OH Vitamin D tend to have more severe symptoms of the disease. Injections and/or supplementation of vitamin D3 10,000 IU a day to raise the level of 25 hydroxy Vitamin D to 65-85 ng/ml may be helpful and reduce the disease activity of lupus. It's important to note that while sunlight exposure is typically an important source of vitamin D absorption, prolonged time in the sun isn't recommended for most lupus patients due to the effect ultraviolet light has on the disease.

Other supplements: In addition to vitamin D, take flaxseeds and fish oil to reduce inflammation. Two tablespoons of freshly ground flax seeds added to cereal or salads every day are an easy and tasty way to reduce inflammation. Fish oil can be taken in gel caps or liquid form, up to 4-6000mg daily and can also be eaten by adding more fatty fish, such as Alaskan salmon, North Atlantic mackerel and sardines, to your diet twice a week. In addition, alpha lipoic acid, cordyceps mushroom extract, green tea with EGCG and turmeric root may be recommended to you.

Naltrexone use: Naltrexone is an opioid receptor antagonist approved by the FDA to treat alcohol and opioid dependency. The usual dose is 25-100mg daily. However, it has many off-label uses, one of which is the treatment of autoimmune diseases. When used as a treatment for lupus, thyroiditis or MS, naltrexone is given at a lower dose of 4.5mg a day. It calms down an over-reactive immune system at this dose.

A Gluten-Free Diet and Elimination of Any Other Problematic Foods: Several integrative doctors have witnessed complete remission of lupus in patients who adhered to a gluten-free diet. It's believed that wheat gluten may be responsible for triggering lupus' autoimmune response in people who are genetically predisposed to the disease. Dr. Christopher Reading in Sydney, Australia, has documentation of more than 500 patients who were effectively cured of lupus by following a gluten- and dairy-free diet enhanced with supplementation of key vitamins and minerals. Food sensitivity testing and subsequent dietary changes are important parts of treating any autoimmune disease, as reactions to wheat, dairy and other foods or ingredients can increase inflammation in the body.

Physicians have witnessed patients healing from chronic disease when the patients started to eat a healthier diet for years. Hippocrates said “Let thy food be thy medicine.” Dr. Gerson cured patients of lupus and various cancers starting in the1930’s by putting them on a minimally processed food diet consisting primarily of fruits and vegetables. In May, 2009, the American Academy of Environmental Medicine recommended that all physicians tell their patients to avoid eating genetically modified foods.  Reducing wheat, corn, dairy, sugar, junk and processed food, and excess sugar is quite a tall order for most people, and it may save your life and cure your illness.

Eliminating Toxins: As mentioned above, the sheer number of chemicals and toxic metals that we have in our bodies is having a huge impact on our health.  So many more people, not just counting those with lupus and autoimmune disease, are getting sick and staying sick. Integrative physicians who test patients for toxic metals routinely find high levels of lead, cadmium, aluminum and/or mercury. When patients reduce the amounts of these in their bodies, they get better. Mercury is a common culprit in MS, lupus, and other autoimmune diseases. Chelation with drugs or elimination with chlorella, micro-silica, and other effective treatments work. Many other toxins like formaldehyde in new trailers, carpeting, furniture made of particle board with plastic laminate, wrinkle free sheets and permanent press clothing can trigger autoimmune disease in those that are sensitive. For an overview of comprehensive detoxification, consult with an integrative practitioner who can guide you through the process effectively.

The most important thing to do is to identify and reduce your exposure to these toxic chemicals. Again, go to EWG to learn about sources of exposure in household furnishings, cleansers and personal care products. Reduce your exposures in areas over which you have control first.

Avoiding Ultraviolet Light: Exposure to sunlight or light from a tanning bed can cause lupus patients to experience a flare-up. When outdoors, wear sunscreen and protective clothing. Go to EWG and select a sunscreen that has a 1-2 rating. Sunscreens can be toxic or ineffective. Avoid prolonged time outdoors without shade during the parts of the day when the sunlight is most direct—10 a.m. to 4 p.m.

Additional Treatments: In addition to the supplements and dietary changes mentioned above, there are other nutritional changes one can make. Zinc, Vitamin A, probiotics and numerous herbs can help support your immune system. Quit smoking if you smoke—smoking worsens the impact of lupus on the cardiovascular system. Don't forget that exercise is a natural anti-inflammatory; regular activity can help improve your condition and your overall health. It's also important for the physician to look for and treat hidden infections, such as yeast, viruses, bacteria, parasites and Lyme. Finally, don't overlook the value of relaxation. Practices such as yoga, biofeedback and massage reduce stress, which improve the body's immune response.

Getting Started
Dr. Hyman recommends that we all practice the precautionary principle, which says that we should avoid anything with the potential for harm. In the US, something has to be proven harmful before it is taken off the market. In Europe, something has to be proven safe before it is allowed on the market. This is also known as “better safe than sorry.”

Find a doctor that will work with you to determine the cause of your autoimmune disease and treat the symptoms AND the causes. Do not give up hope and be willing to make substantive changes in your lifestyle in order to get well.


Nita said...

Dear Dr. Vaughan,
I am writing to hopefully gain some insight from you regarding Multiple Sclerosis. I have had it for 12 years and am in the secondary-progressive stage. I recently met a woman who was diagnosed 4 years ago. I have more symptoms than she has but she read an article that you published and she asked if I could find you and request some help for both of us. Most neurologists have only prescribed pharmasutical drugs to treat our symptoms. Surely there has to be more options regarding our diet, vitamins, etc. We live in Winston-Salem and would love a consult with you if at all possible. I think Margaret said you lived in Greensboro. Please email me if that would be possible.
Sincerely, Nita

Elizabeth Vaughan said...

To make an appointment with me, please call my office at 336.808.3627. Thank you.