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Autoimmune Disease: The Importance of Family History – Naturopathic Doctor News and Review
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AUTOIMMUNE DISEASE: THE IMPORTANCE OFFAMILY HISTORYBy Editor1 Posted April 18, 2016 In Autoimmune/Allergy Medicine
Chad Larson, NMD, DC, CCN, CSCS
In the past 2 weeks, I diagnosed a middle-aged male with celiac disease, and a teenage female with Hashimoto’s
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AUTOIMMUNE DISEASE: THE IMPORTANCE OF FAMILY HISTORY
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thyroiditis. Since their symptoms weren’t really textbook for those conditions, it was their positive family history forautoimmunity that led me down that path. Although current medical literature estimates that genetics only contributeabout 30% of the risk for developing an autoimmune (AI) condition, it’s a good place to start.
START WITH THE FAMILYThe National Institutes of Health estimates that more than 23.5 million Americans suffer from autoimmune diseases.Unfortunately, patients can suffer for 4-5 years before the proper diagnosis is made. If autoantibodies have alreadyattacked 1 organ system, there is a significantly increased chance of your patient developing a concomitantautoimmune condition. As you explore your patient’s family history, do not get too caught up in which particular AIconditions are in the family history, rather just the fact that AI is within the family history – eg, the mom may haverheumatoid arthritis, and the aunt may have lupus, but your patient might have type 1 diabetes.
By diving into family history, you will be better equipped to diagnose and treat not only your patient, but also uncoversome important information for their own children. We like to start out with the first-degree relatives (mom, dad,siblings), and branch out from there. Then be sure to include grandparents from both sides, and even aunts, uncles,nieces, and nephews. If any of the family members are deceased, identify the cause and age of their death. I also findit helpful to record current ages, medical conditions, and age at the time of the diagnosis. When there is a positive AIfamily history, have the patient compile the information and share it with their relatives so that they, too, can assesstheir chances of developing an autoimmune disease. Furthermore, recommend that the family members share theinformation with their doctors, so we can start to decrease this time lag before proper diagnosis and treatment.
LABORATORY TESTINGAt this point, we need high-quality and comprehensive lab testing to match up the subjective and objectiveinformation and confirm the diagnosis. There can be a lot of crossover of symptoms between all of the AI conditions,such as fatigue, gastrointestinal complaints, joint pain, rashes, and generally feeling unwell. There is the typical AI labworkup that we want to order, eg, CMP, CBC, CRP/ESR, and ANA, but we also want to move beyond theconventional markers and test for factors such as intestinal permeability; this is because, in my experience, a personwith an AI condition has leaky gut until proven otherwise. And I hear what you’re thinking – you just assume theyhave it and treat accordingly. However, like we learned in school, we want to diagnose before we treat, and moreimportantly, leaky gut can be a major gateway to autoimmunity. So, we need to test, treat, and then retest to make surethe gut barrier is repaired.
It’s important in any workup for autoimmunity to evaluate gluten sensitivity. Research indicates that only 50% ofindividuals with celiac disease react to alpha-gliadin, which is the only gluten peptide that most labs test for. Butwhat about other gliadin peptides, like gamma- or omega-gliadin? Many researchers are now suggesting that the onlyway to accurately diagnose celiac disease is to evaluate multiple gliadin peptides, not just alpha-gliadin. I personallylike to use a lab that specializes in immune dysregulation and offers all of these gluten peptides; it also has an
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Autoimmune Disease: The Importance of Family History – Naturopathic Doctor News and Review
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intestinal permeability test that seems a major step up from the lactulose-mannitol test. The earlier we can diagnoseand initiate treatment for our AI patients, the faster we can help them into remission or at least manage theirsymptoms.
CLOSING COMMENTSI don’t know about you, but I was initially somewhat reluctant to go down the autoimmune clinical pathway. But itjust kept showing up in my practice, so I needed to keep getting educated on how to diagnose and treat it. I thoughtonly rheumatologists treat AI conditions; however, I quickly learned that they are generally not interested in lookingfor the trigger(s) to the immune hyperactivity. This is an important clinical opportunity for us to help our patients in away that our pharmaceutical counterparts are not. A comprehensive family history is a good start.
Chad Larson, NMD, DC, CCN, CSCS, holds a Doctor of Naturopathic Medicine degreefrom Southwest College of Naturopathic Medicine, and a Doctor of Chiropractic degreefrom Southern California University of Health Sciences. He is a certified clinicalnutritionist, as well as a certified strength and conditioning specialist. He is also anindependent expert consultant and advisor for Cyrex Labs. Dr Larson particularly pursuesadvanced developments in the fields of endocrinology, orthopedics, sports medicine, andenvironmentally-induced chronic disease.
References
1. National Institute of Environmental Health Sciences. Autoimmune Diseases. November, 2012. NIH Web site.
https://www.niehs.nih.gov/health/materials/autoimmune_diseases_508.pdf. Accessed September 1, 2015.
2. American Autoimmune Related Diseases Association, Inc. AARDA Facts. Available at: http://www.aarda.org/about-aarda/aarda-
facts/. Accessed September 1, 2015.
3. Cojocaru M, Cojocaru IM, Silosi I. Multiple autoimmune syndrome. Maedica (Buchar). 2010;5(2):132-134.
4. Vader W, Kooy Y, Van Veelen P, et al. The gluten response in children with celiac disease is directed toward multiple gliadin
and glutenin peptides. Gastroenterology. 2002;122(7):1729-1737.
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