Losing the Immune System Set Point
The immune system. Not upregulated. Not downregulated. But both at the same time.
So how does the immune system become so disrupted that a person develops an AD? The immune system is a great example of how the body loves balance. In most areas, you don’t want to be too high or too low. There is a “sweet spot” or “set point” right in the middle (Figure 6.2).13 Having a low iron level is bad just as having too much iron is bad also. Having two little estradiol is bad but so is too much estradiol. When a person loses the immune system “set point,” their system starts to become both upregulated and downregulated at the same time. Upregulated immune system issues include allergies, asthma, and all the ADs. Downregulated immune system issues include colds, flus, infections, recurrent infections, and cancer.13 As time marches on, they develop new immune system issues on top of the old ones. This is why, when a person develops one AD, they are more likely to get a second, third, fourth, or fifth.14
Oftentimes, when someone is diagnosed with AD, they are offered medications that try to suppress the overactive or upregulated aspect of the immune system dysregulation. They try and push the immune system down. Thus, the person is told “oh, by the way, these medications will increase your chance of getting cancer or an infection that could kill you.”515 Now, if a person knows that the immune system dysregulation has already caused not only an AD but an increased risk of cancer and infections, they may say “this doesn’t seem quite right.” And our immune system agrees. Our immune system doesn’t really want suppression. What it really wants is immune system rebalancing and immune system modulation.
Now, there is nothing wrong w'ith using these medications. What is wrong, is thinking that these medications actually fix the problem. What is wrong is thinking that these meds are the only options to treat AD. Only use DM ARDs or biologies. Only use NSAIDs. Only use opioids. Only use a combination of all these for ADs. Yes, the DM ARDs, biologies, and NSAIDs may protect against tissue damage and changes seen on X-rays. Or, opioids may help patients get out of bed in the morning. But at what cost when they are the only options offered? What is wrong is thinking that the risk/ reward profiles of these meds are so much better than other options that even the thought of using other options is nonsensical. (See Case Study 2 for more details.) By the time someone has finally been diagnosed with an AD, their functional abilities and quality of life are oftentimes profoundly compromised. Something has to be done as quickly as possible to help them. These medications can potentially provide this help. But what they really should be doing is buying time to go back and do our due diligence in finding out why this person has developed the AD in the first place. Address the causes identified through testing and allow them to feel even better than they did on the medications alone. Eventually, they could potentially be in a position to not need these medications or use at much lower doses and minimize any side effect potential. Or, given the long history of immune system dysregulation and events that negatively impact the immune system beginning years and decades before the actual diagnosis of an AD, can we not address the problem before these meds are even needed? The Case Studies 1-3 will highlight this.
The unfortunate story of one of rock and roll’s greatest icons from the 1970s can illustrate this point. Glenn Frey of the Eagles was diagnosed w'ith rheumatoid arthritis. He used the medications typically used for almost 20 years. When he died in January 2017, did he die from rheumatoid arthritis? No! He died from the “sudden” development of a second AD, ulcerative colitis, and an infection, pneumonia, that no amount of antibiotics could successfully treat.16 By having a dysregu- lated immune system and then only using the typical medications that simply suppress the immune system, he was always more likely to get an infection, including an infection that no amount of antibiotics could treat. By not actually rebalancing the immune system, he was more likely to get a second AD on top of his first one. There are also thousands of documented occurrences of these type of medications actually causing a new AD to develop as a side effect.1317
The immune system dysregulation can start very early in life and then only show up decades later as pain and AD. Or it can be so severe that a person develops pain and AD even as a young child. The classic scenario might go as follows. Eczema present since birth. An infection w'ith first antibiotic use at less than one year of age. Recurrent ear infections, sinus infections, or strep throats as a child. Development of allergies or asthma as a child or teenager. Mononucleosis, an Epstein- Barr virus infection, in high school. Or any number of other infections that a young person can get. Already this person’s immune system is showing the loss of the set point early in life. Then this disruption just keeps rolling along as the years go by, eventually causing pain and AD.
So, what causes the immune system to lose its set point and move away, both up and dowrn, at the same time? Vitamin deficiencies, hormone deficiencies or imbalances, toxicity, toxic stress, chronic infections, and the gut (Figure 6.3).18-23 The gut is possibly the central mechanism. When the gut is not functioning
properly, we cannot digest and absorb nutrients from the food we eat, so we develop vitamin and mineral deficiencies. Furthermore, hormone balance can be altered as many hormones undergo enterohepatic circulation.22 The gut produces important hormones that can impact pain such as melatonin.24 Low' levels of melatonin have been linked to many pain conditions including FM, and endometriosis-related chronic pelvic pain as w'ell as tension, cluster, and migraine headaches.25 Furthermore, toxic burden can increase w'hen gut function is altered, and there is a major detoxifying pathway in the liver also.26 This includes environmental toxins as well as toxins produced every day by our ow'n cells as toxic byproducts of metabolism. And when the gut gets throwm off, this will directly affect the immune system because 80% of our immune system actually surrounds the gut.27 A dysfunctional immune system cannot keep problematic microorganisms out of our bodies, and we develop chronic infections.
Knowing w'hat causes the immune system dysregulation makes it easy then to know' w'hat tests to run in order to get the information we need to optimally treat the person w'ith pain and AD. This is because much, if not all, of the pain is being driven by the same exact processes which caused the AD (Figure 6.4).
