Autoimmune diseases affect about one in five (20%) of Americans, according to the American Autoimmune Related Diseases Association. Chronic inflammation also affects nearly 125 million Americans, while inflammation plays a role in more than 50% of all deaths in the US.
In addition, in the United States, rheumatoid arthritis affects about 1.3 million people, with the annual financial burden of approximately $19.3 billion dollars, while Psoriasis affects over 8 million people, and Crohn’s disease over 50,000. Irritable Bowel Syndrome also affects up to 10-15 percent of United States adults.
Autoimmune and metabolic conditions we treat
Musculoskeletal Issue
Ankylosing Spondylitis, Fibromyalgia, Lupus, Chronic Back Pain, Rheumatoid Arthritis, Psoriatic Arthritis
Skin Conditions
Psoriasis, Rosacea, Dermatitis, Eczema, Acne, Chronic Urticaria (itching)
Gastrointestinal Issues
Crohn’s Disease, Ulcerative Colitis, IBS, Gastroesophageal Reflux Disease (GERD), Small Intestinal Bacterial Overgrowth (SIBO)
Ankylosing Spondylitis
Ankylosing spondylitis is a type of inflammatory arthritis that affects the axial skeleton then spreads to other joints. It tends to begin with sacroiliac joints and spinal joints, causing low back or sacroiliac pain that is worsened by being still and improves on movement. The symptoms can include pain in other joints, such as the ankles, middle back, neck, or shoulders as well.
Over time, these joints can become completely fused together, or “ankylosed.” The symptoms at that point can shift to a stiffness and loss of range of motion, often resulting in a posture that is flexed forward. AS can spread to other joints including the hands. If the affected joints include the ribs, this can hamper deep breathing as the joints begin to fuse.
This type of arthritis is also considered autoimmune, in that immune cells are leading an attack on joint tissue. Over the long run, the most consistent finding is joint inflammation, leading many to call it inflammatory. In truth, AS has both autoimmune and inflammatory aspects. Some people with AS also experience digestive problems, such as loss of appetite.
Fibromyalgia
Fibromyalgia is a chronic pain syndrome affecting the muscles. It is diagnosed by finding chronic and bilateral pain and tenderness on at least 11 of 18 specific trigger points, occurring over at least three months. Fibromyalgia is thought to occur as a result of central pain sensitization, secondary to inflammatory changes.
The symptoms of fibromyalgia include:
• Muscle pain
• Poor sleep
• Anxiety
• Depression
• Fatigue
• Gastrointestinal problems can also occur
• Chronic fatigue syndrome
• Mood disorders
• Other inflammatory conditions
Because the pain can be severe and of long duration, fibromyalgia may cause a general state of depression. There may also be mental changes, such as poor memory, difficulty thinking, or a generalized “brain fog” type of feeling, and many patients experience headaches or migraines as well
Lupus
Lupus is a complex autoimmune disease that can affect:
• Skin
• Joints
• Kidneys
• Heart
• Lungs
• Brain
• blood cells
• blood vessels
It’s a heterogeneous disease that affects people differently. Lupus may occur due to genetics, but it can also be triggered by sunlight, infections, or medication reactions such as anti-seizure, antibiotics, or some blood pressure medications.
Lupus is known for its characteristic presentation of inflamed skin on the face, and yet it can affect many other systems in the body. When lupus affects many parts of the body it is known as systemic lupus erythematosus (SLE).
The symptoms of Lupus are many, but the most common symptom is the classic red “butterfly-shaped” facial rash over the cheeks and nose, but below the eyes. The rash often manifests after sun exposure, though if this happens the patient probably already had lupus. Other symptoms are secondary to the region of the body that is affected, and include:
• Facial rash, though it can also appear on the hands, arms, or other areas exposed to sunlight
• A fever over 100 degrees can result from inflammatory reactions during Lupus flare ups.
• Muscle and joint pain is very common, and can occur in the neck, thighs, shoulders, or arms
• The lungs can become inflamed and cause chest pain on deep breathing
• Ulcers and sores can occur in the mouth, cheeks, or gums as well as the lips
• Lupus can affect red blood cells, causing anemia and fatigue
• When lupus affects the brain it is known as lupus cerebritis, which can cause memory issues
• Blood clots may occur, causing deep vein thrombosis or potentially resulting in a stroke, myocardial infarction, or thromboembolism. The symptoms could include painful red swelling of a leg, chest pain on stress or exertion, or sudden difficulty breathing, as well as facial or upper extremity asymmetry and loss of sensation or motor control
• Lupus may also result in a rash on the eyelids, inflammation of the eye, or dry eyes
• Lupus Nephritis is another serious complication of SLE. It’s a complex condition with different subtypes and advanced cases can lead to kidney failure requiring dialysis
Chronic back pain
Back pain can occur for a variety of reasons, but one of the most common is systemic inflammation. If back pain persists for more than twelve weeks, it is considered chronic back pain. The causes of chronic back pain can include:
• Arthritis of the spine, secondary to inflammatory changes
• Inflammation of a spinal disc, herniated disc or degenerative disc disease
• Muscle or ligament strain caused by injury, overuse or improper use of the back muscles.
• Spinal stenosis, an arthritic narrowing of the central spinal canal
• Scoliosis, an abnormal sideways curvature of the spine
• Nerve related conditions like sciatica where the sciatic nerve is compressed or irritated causing pain
• Inflammation of the kidneys
The common denominator in these causes is excess inflammation. Poor posture, biomechanics, or distortions of the spine such as scoliosis result in a chronically inflamed spine, though a predilection to excess inflammation is usually still a factor.
The symptoms of chronic back pain are defined by:
• Back pain of gradual and not sudden onset,
• Lasting for twelve weeks or more
• Pain that can’t be blamed on a musculoskeletal injury
• Does not seem to resolve on its own
• Nature of the pain may be a deep aching or may be a burning, and it may be localized or it may radiate to other areas
The pain from chronic back pain is typically worsened by being sedentary, such as sitting for extended periods of time. Pain may radiate from the back into a leg, hip, or buttock but will not usually follow the course of a specific nerve root. The pain may be worsened by an initial bending or movement, but in general it is relieved by movement.
Lower back pain is the most common type of chronic back pain and estimates suggest that about 619 million people worldwide experience chronic lower back pain at some point in their lives.
Rheumatoid Arthritis
Rheumatoid arthritis is an inflammatory autoimmune condition that primarily affects the joints.
• The most common age of onset is between 35-60 years of age
• It can also occur as early as teenage years
• The incidence is highest in those 60 years of age
• When it does occur early in life, it is known as juvenile rheumatoid arthritis or JRA
• The condition results in severe inflammation and enlargement and destruction of the affected • joints, resulting in angular deformity of the joints
• The hands are the most affected region, with knees and wrists also very commonly affected
• Rheumatoid arthritis also increases the risk of heart disease, diabetes, and other conditions related to inflammatory or autoimmune reactions
The symptoms of RA include:
• Pain
• Aches and stiffness in multiple joints, particularly in the hands and also affecting both sides of the body
• Swelling and tenderness in the joints is also a symptom
• More generalized symptoms that typify an overactive immune system include fever, fatigue, and weakness.
Psoriatic Arthritis
Of the eight-million plus people in the United States who have psoriasis, it is estimated that almost one-third have psoriatic arthritis. This type of arthritis can cause swollen joints that become tender, as well as swelling on the back of the lower leg above the Achilles tendon.
Patients may feel stiffness in the morning, fading as they move about during their day. The progressive joint damage from psoriatic arthritis can result in significant loss of use.
Psoriasis
Psoriasis is an inflammatory autoimmune skin condition that causes:
• Red, flaky, and itchy patches of skin
• The severity of the condition is graded by the percentage of surface area affected on the body
• This condition can also affect the joints, causing inflammation, pain, and joint damage
• Psoriasis can occur at any age, though it most often begins between the ages of 30 and 50
The symptoms of psoriasis vary depending on the type of psoriasis. Psoriasis presents in various forms, each with distinctive characteristics:
• Chronic plaque psoriasis, the most prevalent type, constitutes about 80% of cases and is • recognized by itchy, raised, and scaly patches, primarily affecting elbows, knees, low back, or scalp, sometimes spreading widely
• Guttate psoriasis causes small, scaly bumps, resolving in weeks or months
• Inverse psoriasis forms smooth, red lesions in skin folds
• Pustular psoriasis presents as pus-filled bumps on hands and feet, sometimes spreading widely with systemic symptoms
• Erythrodermic psoriasis, severe and life-threatening, causes extensive redness and illness-like symptoms
• Nail psoriasis leads to discolored, indented nails that may detach
Rosacea
This is a long-term inflammatory skin condition, causing redness in the cheeks and nose, often with visible small blood vessels.
• It is exacerbated by sun exposure or stress
• Rosacea may occur and then go into remission depending on lifestyle and stress factors
• It can result in a rash resembling acne
• Rosacea sometimes affects the eyes as well
• Rosacea is associated with small intestinal bacterial overgrowth (SIBO), Helicobacter pylori infection, and inflammatory or irritable bowel disease
• It has also been considered as a cutaneous gluten reaction that occurs in people with celiac disease or non-celiac gluten sensitivity
While rosacea may appear as little more than some redness, perhaps suggestive of a localized sunburn, in some cases the presentation can be much more acne-like. Skin thickening, bumps and pimples can create significant symptoms. In addition, because it is on the face, rosacea can have a significant impact on self-esteem and confidence.
The National Rosacea Society has claimed that almost 90 percent of those with this disorder say that it diminishes their self-esteem and confidence, while 41 percent say that it has affected them so much that they avoid contact with others or social activities.
Eczema
Eczema is an inflammatory skin condition that can take several forms. Eczema is another name for the condition known as atopic dermatitis. The condition may resolve for a period of time, only to flare-up later. Severe eczema is associated with food allergies and asthma. Types of eczema include:
• Dyshidrotic eczema
• Nummular dermatitis
• Seborrheic dermatitis
• Stasis dermatitis
Symptoms include itchy and dry skin, with rashes that may become scaly, blistered, or infected. The appearance of affected skin may be reddish and inflamed, or in people with darker skin tones it may appear as brown or gray patches.
The most common single symptom of eczema is itching. Eczema may begin at any stage of life, and severity may range from small patches of skin to very large areas. In addition, the severity can vary from simple redness and itching to scaling, blistering, and infection.
Acne
This is an inflammatory condition of the skin that affects the sebaceous oil glands that normally release sebum onto the hair itself. Acne results when skin inflammation causes the keratin cells lining the pores and the hair to stick together, occluding the pore and trapping the sebum inside.
The accumulation of oils and dead cells provide an environment that promotes bacterial growth. Eventually the growth, which we call a pimple, ruptures and the bacteria and sebum affect adjacent skin. In this way, patches of skin become affected by the process, and the pimples seem to spread.
Acne is also thought to result from intestinal issues such as SIBO or gut inflammation. In this mechanism, increased intestinal permeability known as “leaky gut” can allow bacteria and other particles to leak out into the bloodstream. When these encounter the capillaries in the skin, bacteria can promote a localized infection in the skin, resulting in acne.
Chronic Urticaria
Urticaria, also known as “hives,” is a skin condition that results in raised welts that are extremely itchy. These welts may last for weeks and may return repeatedly over a period of years. These begin as reddish inflamed patches of skin that swell and become the welts characteristically called hives.
The itchiness of hives can be extreme, affecting sleep and daily function as well as being very uncomfortable in general. Urticaria can occur spontaneously, or can exist continuously.
Crohn’s Disease
Crohn’s Disease is a type of Inflammatory Bowel Disease (IBD). Crohn’s Disease typically affects the last part of the small intestine and the first part of the large intestine, though it can affect any part of the digestive tract from mouth to anus. Crohn’s disease that affects different parts of the digestive tract may result in different symptoms.
The symptoms of Crohn’s disease can include:
• Pain in the abdominal area
• Joint pain, or rectal pain
• Intestinal bloating and cramping
• Bloody stools
• Fatigue
• Weight loss
• Diarrhea
Over time these changes can result in weight loss. Additional symptoms that are possible with Crohn’s include mouth sores, fever, and anal fistulas that can cause pain and fluid drainage of pus near the anus. Fecal urgency and reduced bowel control can also result.
Sections of the affected intestine may become constricted, causing spasm and pressure as intestinal contents attempt to pass through a restricted section.
The inflammation of the inner lining of the digestive tract can also affect the full thickness of the intestinal wall, leading to additional complications. Because Crohn’s can affect any part of the entire digestive tract, the symptoms may vary depending on the affected region. In contrast, ulcerative colitis only affects the colon, making its symptoms more consistent.
Crohn’s can also result in symptoms unrelated to the digestive tract. These can include arthritis, liver disease, kidney stones, inflammation of the eyes, or skin problems.
Ulcerative Colitis
Ulcerative Colitis is another type of inflammatory bowel disease that results in ulcerative lesions along the lining of the colon and rectum. Ulcerative colitis occurs when genetics and diet affect the immune system in a way that results in inflammation (and possibly also autoimmunity) of the rectum and colon.
It is also believed that dysbiosis of the microbiome as well as bacterial or viral infections can trigger this type of excess immune reaction. Diet plays a role, with a positive association having been shown between dietary sugar intake and the risk of developing ulcerative colitis.
Ulcerative colitis can occur gradually, resulting in:
• Bloody diarrhea
• Mucus discharge
• Abdominal pain, though not as often as in Crohn’s disease
• Nocturnal defecations
• Fatigue
• Fever
• Weight loss can also occur with ulcerative colitis
• Some patients may experience periods of remission, though it is considered to have no cure.
Because the ulcers produce excess mucus and pus, there is an increased frequency and urgency of bowel movements, and they will contain blood, pus, and mucus as well as feces.
Ulcerative colitis differs from Crohn’s disease in that UC affects only the rectum and colon, not the rest of the digestive tract. In addition, UC specifically attacks the innermost lining of the colon and rectum, whereas Crohn’s lesions can also affect the full thickness of the intestinal wall.
Irritable Bowel Syndrome
IBS is a condition which is the result of irritation of the colonic lining. IBS also has subtypes, based on the pattern of symptoms. IBS-C is irritable bowel syndrome that causes constipation, whereas IBS-D includes diarrhea, and IBS-M has a combination of both. This is called a “syndrome” because it can consist of a variety of bowel-related symptoms.
The symptoms of IBS include:
• Episodes of diarrhea or constipation
• Abdominal pain, gas, and cramping
• Straining to defecate, muscle pain, bloating, and an overall sickly feeling
Irritable bowel syndrome significantly affects the patient’s quality of life, as all activities must be structured or scheduled around the unpredictable need to find a bathroom. Even between bathroom sessions, IBS patients typically feel unwell and can experience symptoms on a continual basis. This can result in an overall feeling of fatigue, often accompanied by anxiety or depression.
The factors promoting IBS can include imbalanced gut bacteria or SIBO, as well as dietary factors. Starches and sugars are strongly implicated in IBS, with research showing that a diet low in starches and sugars reduces the symptoms of IBS. A low-FODMAP diet, which is a diet low in fermentable carbohydrates, has also been shown to help IBS sufferers find some relief.
Gastroesophageal Reflux Disease (GERD)
Normally, food that is being digested in the stomach remains in the stomach because the lower esophageal sphincter muscle keeps it there, so that it doesn’t regurgitate up into the esophagus. This is important because the esophagus is not designed with the needed protection to deal with the acid and enzymes produced in the stomach during digestion.
When the lower esophageal sphincter fails to keep stomach contents properly contained, the acid and enzymes flow back into the esophagus. This results in irritation and inflammation of the esophageal lining.
The symptoms of reflux include:
• Heartburn, which is a deep burning feeling inside the chest
• This may occur after eating
• Triggered by lying down to sleep or even just bending over
• If it occurs during sleep, it may wake the person, resulting in disturbed sleep patterns
• In some cases, regurgitation may occur into the throat and sinus cavities, causing symptoms related to these areas
• This may be felt as a chronic cough or need to clear the throat, a chronic sinus infection, inflamed vocal cords that make it difficult to speak clearly, or a reactive airway to cause asthma
The symptoms of GERD make it somewhat challenging to properly diagnose. This is particularly the case when the stomach’s production of hydrochloric acid is lacking, a condition known as hypochlorhydria. When this occurs, there may not be any burning sensation during the reflux, as there is not sufficient stomach acidity to cause burning.
This type of reflux is also non-erosive, so there won’t be any lesions to visualize during an endoscopy. This is known as “silent reflux” because of the absence of burning sensation. Silent reflux can affect the larynx, in which case it may be called laryngopharyngeal reflux disease or LPRD.
This variant causes inflammation and irritation of the throat and sinuses, because the esophagus, throat, and sinuses are unprotected from the digestive enzymes and remaining acidity.
Small Intestinal Bacterial Overgrowth (SIBO)
Bacteria are normally prevented from colonizing the small intestine. Stomach acidity provides a filter that prevents ingested bacteria from passing through the stomach, and conjugated bile acids released from the liver and gallbladder inhibit bacterial growth. However, in some situations, bacterial overgrowth may occur in the small intestine, and this is known as SIBO.
SIBO can be the result of using acid-blocking medications for the treatment of GERD, or this reduced acid production can result from Helicobacter pylori infection as well as the aging process. Reduced motility of the small intestine also can cause SIBO. This reduced motility can be the result of autonomic neuropathy that is secondary to type 2 diabetes.
A slowing of the small intestine’s normal peristaltic motion results in increased time for bacterial growth, potentially allowing bacteria from the more distal intestine to migrate to the small intestine.
SIBO can also result as a side effect of bariatric surgery, with an incidence of 43%. SIBO can also result from:
• Hypochlorhydria
• Radiation therapy
• Birth defects in intestinal architecture
• Surgical gut resections
• Diabetic autonomic neuropathy
• IBS
• Connective tissue disease
• Crohn’s disease
• Liver cirrhosis
• Celiac disease
The symptoms of SIBO extend beyond the small intestine itself, and include:
• Chronic diarrhea as well as reduced absorption of nutrients from the small intestine
• Abdominal pain
• Bloating
• Full feeling after eating
• Weight loss
• Malnutrition
• Nausea and loss of appetite
Celiac Disease
Celiac disease is a type of autoimmune disease that is triggered by gluten, resulting in inflammation and tissue damage to the intestinal lining. Gluten breaks down into several molecules, including gliadins, which increase intestinal permeability.
Once permeability is increased, gluten is able to cross the intestinal membrane barrier, triggering immune reactions in the bloodstream and tissues. Celiac disease can cause diverse symptoms:
Intestinal-related symptoms include:
• Diarrhea
• Bloating
• Constipation
• Abdominal pain
Extraintestinal symptoms include:
• Iron or folate deficiency anemia
• Vitamin D deficiency
• Rickets
• Low calcium levels
• Reduced childhood growth
• Dermatitis herpetiformis
• Osteoporosis
• Ataxia
• Recurrent abortions
• Depression and anxiety
• Autoimmune thyroiditis
Celiac disease often occurs in conjunction with other autoimmune conditions such as:
• Hashimoto’s thyroiditis
• Dermatitis herpetiformis
• Cerebellar ataxia
• Diabetes
• Addison’s disease
• Sarcoidosis
• Psoriasis
• Rheumatoid arthritis
• And many others
Antibodies to gluten, gliadin, or transglutaminase also can cross-react to other tissues in the body through molecular mimicry, resulting in inflammation or autoimmune reactions. The only recognized and effective treatment for celiac disease is a strict gluten-free diet.
Current Treatments For Inflammatory and Autoimmune Diseases
Treatment options for inflammatory or autoimmune conditions generally consist of anti-inflammatory or immunosuppressant medications.
Anti-inflammatory drugs are generally either nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. The NSAIDs are commonly available without a prescription, and include drugs such as aspirin, ibuprofen, or naproxen, though more powerful drugs are also available.
As a group, NSAIDs have significant and consistent side effects, resulting in ulcers in the stomach or intestines, intestinal inflammation, cardiovascular events, high blood pressure, kidney failure, and an exacerbation of preexisting heart failure.
Anti-inflammatory drugs are generally either nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. The NSAIDs are commonly available without a prescription, and include drugs such as aspirin, ibuprofen, or naproxen, though more powerful drugs are also available.
As a group, NSAIDs have significant and consistent side effects, resulting in ulcers in the stomach or intestines, intestinal inflammation, cardiovascular events, high blood pressure, kidney failure, and an exacerbation of preexisting heart failure.
NSAIDS also imbalance gut bacteria significantly, causing “NSAID enteropathy.” This class of drugs is known to damage the intestinal barrier, causing abnormally increased gut permeability or “leaky gut.”
The combination of digestive tract inflammation, ulcers, and gut dysbiosis makes NSAID therapy a poor and risky long-term therapeutic choice for inflammatory disease.
Corticosteroids are drugs that mimic the effects of the natural steroid hormones that are produced by the adrenal cortex, just over the kidneys. Corticosteroid drugs inhibit the production of inflammatory cytokines, chemokines, and other parts of the inflammatory cascade. While they are effective in reducing inflammation, this class of drugs produces side effects in almost all (90%) of patients.
These side effects of corticosteroids can be quite serious, including:
• osteoporosis producing bone fractures
• Adrenal suppression and reduced cortisol production
• Cushing syndrome
• High blood sugar or diabetes
• Muscle pain and pathology (myopathy)
• Visual disturbances; glaucoma or cataracts
• Reduced immune function
• Heart disease
• Skin atrophy and thinning
Because of the consistency and severity of the symptoms, steroid therapy presents significant problems as a long-term treatment for inflammatory or autoimmune diseases.
Immunosuppressive therapy is most commonly accomplished with “biologic” drugs. These are a class of drugs that includes vaccines, blood components and monoclonal antibodies. They generally work by attacking or inhibiting parts of the inflammatory cascade. These include tumor necrosis factor (TNF) inhibitors, beta cell inhibitors, T-cell inhibitors, and interleukin inhibitors.
Of these, some of the most commonly used for inflammatory or autoimmune disease are TNF inhibitors and interleukin antagonists. Common examples are Humira, Orencia, Enbrel, or Remicade.
The side effects of these biologic immunosuppressive therapies are not mild, and can include:
• Serious infections such as tuberculosis, fungal or viral infections, and cancers such as lymphoma or skin cancers.
• Hepatitis B
• Allergic reactions
• Numbness or tingling
• Weakness in arms and legs
• Heart failure
• Bleeding disorders
• Lupus
• Liver damage
• Psoriasis
• Upper respiratory infections, headaches, rash, and nausea can also occur
Biologic immunosuppressive drugs are given as an infusion through an IV at a doctor’s office, though some of them can be administered by injection. They are some of the more expensive treatments, often costing several thousand dollars every month.
The severity of the side effects, combined with the inconvenience of infusions, and the expense of this class of medications makes them less than an optimum choice for many patients.
Revero’s root-cause treatment
Revero’s nutrition therapy treats inflammation and autoimmune diseases with a low-carbohydrate diet that eliminates inflammatory foods. By identifying and removing food sensitivities, this approach reduces systemic inflammation, glucose, and insulin levels.
This approach promotes weight loss in overweight or obese people, providing health benefits without the risk, expense, and inconvenience of pharmaceutical treatment.
