Supplements for autoimmune disorders

Executive Summary

Autoimmune conditions are some of the most difficult conditions to handle: no single enemy, no single location, and no single mechanism of action. The supplements suggested:

Necessary:
Omega-3 oils: 1,000 mg a day;
Vitamin D: 2000 IU a day;
Curcumin: 500 mg a day;
Coenzyme Q10: 300 mg a day; and
Probiotics: 20 billion CFUs (colony forming units) a day.

Optional:
B-vitamins;
Prebiotics or Fiber;
Glutathione;
Selenium; and
Zinc.

Read the full article for their purpose and what results to expect from them.

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Autoimmune disorders develop when your body’s immune system mistakenly attacks and damages its own healthy tissues. They are some of the most difficult conditions to manage. That is partly because so little is understood about what really causes them and how they progress. However, with proper treatment, dietary and lifestyle changes, and supplementation, they can be kept in check.

Unlike heart disease and diabetes, very little is known to the public about autoimmune disorders. So the first step is a broad understanding of how these diseases may develop and progress. Individuals who suffer from them do many wrong things out of sheer ignorance, aggravating the situation. It is almost like being a diabetic and still regularly eating sugary sweets.

In this article, I will discuss how a malfunctioning immune system causes autoimmune conditions and supplements that may help.

Introduction

Autoimmune conditions are a set of more than a hundred diverse medical conditions. Some examples of autoimmune disorders are type 1 diabetes, psoriasis, inflammatory bowel disease, and rheumatoid arthritis.

Their name—autoimmune—signifies why they are so hard to treat or control. Auto means self, and immune refers to the body’s immune response. Autoimmunity is caused when your body’s immune system attacks the body’s own tissues.

There lies the dilemma in the management of autoimmune conditions. Your immune system works fine against the outside bacteria and toxins. But it also damages your own body. If you try to hinder the immune system, your autoimmune problems will subside but you will face increasing vulnerability to external enemies like microbes. That is the challenge.

Our Immune System

During the Covid pandemic, we learned a lot about how our immune system functions. But that was about external attackers such as the SARS-CoV-2 virus. Preventing autoimmunity is a different aspect of our immune system.

The main question is how our immune cells know which cells are internal and which ones are of the outside parasites. In normal times, our well-honed immune system is able to identify the external invaders that enter the body, such as microbes and toxins. Certain immune cells are able to verify those entities as non-self—’not a part of me’. Then, some other immune cells destroy those external entities.

The immune system recognises that there are two, er, things: self or a part of the body itself and non-self or a part that is genetically different from the body. Then, it acts: leave the self alone and destroy the non-self. But those are the only tasks our immune system does. It actually does four things:

1. Identifies and destroys non-self entities, such as unhealthy microbes;
2. Identifies self entities and leaves them alone, such as all your healthy body tissues;
3. Identifies and destroys self entities that have some defects developed in them and need to be destroyed, such as cancerous cells; and
4. Identifies non-self entities that need to be retained and leaves them alone, such as a fetus (which is genetically distinct from its mother) during pregnancy or gut bacteria.

How does the immune system know which object inside the body belongs to it and which one is an external one? How does it know if a cell is damaged and needs to be destroyed? And what about non-self entities that need to be left alone?

How Does the Immune System Work?

All cells have certain identification molecules called antigens. They may be inside a cell, on its surface (bacteria or cancer cells), or as a part of their genetic material (viruses). Food molecules and pollen have many chemicals in them that act as antigens.

All the cells of our body have the same main antigens. Besides these, some organ cells may have separate antigens, which signify that they are those specific cells of our own body. For example, our heart cells have antigens that tell our immune cells that they are our heart cells.

The external microorganisms have different antigens than our body’s own cells. All antigens act like identity cards.

The immune cells go around checking the identity cards of the cells around them. If those security guards of the body find identity cards or antigens that do not match the host’s (ours), they consider the cells as external or non-self and proceed to destroy them.

Some scientists define antigens as substances that can induce an immune response in the body. But that is not correct. In the case of certain antigens, the immune system does not and should not respond. For example, the second (leaving alone self-entities) and the fourth (leaving alone non-self entities like gut bacteria) tasks mentioned above.

Remembering the Enemy

The immune system needs many days to launch a full-fledged immune attack against an enemy parasite. This has a cost: sometimes, the invading microbe can overwhelm the body in a short span of time. So the immune system needs to figure out how to gear up quickly for the attack. Obviously, it cannot do that for a new type of enemy but it hopes to do so at least for the same type of enemy if it encounters it again.

As a result, our immune system is a learning machine. Not only does it destroy the enemy cells, but it also keeps track of what they were and how they were destroyed. This way, it has a ready reference for the future, in case that same type of pathogen attacks the body again.

The cells of our immune system fight, kill, and chop those external enemies into pieces. Then, some of the immune cells retain those war trophies on their surfaces.😱 Sorry to carry that analogy too far; well, it is not that gruesome.🤪 In reality, a few specialised immune cells retain antigen proteins from the enemy microbes on their own surfaces.

A few copies of such cells circulate in the blood. That is the reference sheet for our immune system about that parasite. In case the same microbe attacks the body, our immune system is able to match the antigens on that microbe’s surface with this reference card and know that it had encountered the same pathogen earlier. Then, it is able to gear up quickly to stop that enemy.

Collecting the Enemy Records

Every new pathogen attack ends up with a few new immune cells that carry their antigen records. Over a period of time, the immune system develops a collection of such immune cells. That is its ready reckoner of the enemies and the war strategies that worked against each of them. The immune system has effectively learned about all the enemies it has fought in the past and how to deal with them in the future.

Vaccination helps create such new records without a large-scale risk of infection. Some such records stay for life and some others fade away after a short duration. That is why you need a flu vaccine every year, a typhoid vaccine every two years, a tetanus vaccine every ten years, and a measles vaccine only once in your life.

Underactive Immune System

If your immune system is underactive or weak, out of the four tasks listed earlier, it won’t be able to do the first (killing pathogens) and the third task (killing cancer cells) correctly. You are vulnerable to infections and various cancers.

This is a common occurrence in our lives. For example, when we are stressed, sleep-deprived, nutrient-deficient, or suffering from some illness, our immunity is low. We may catch bacterial or viral infections during those times. In fact, if you get an infection, most often it is a sign of low immunity. Plus, there is an additional risk.

It is said that in a healthy body, nearly one million cells turn cancerous every day. This occurs because, in trillions of our body cells, oxidation reactions such as energy production happen continuously. Some of them can cause genetic mutations modifying the cell’s DNA. Some damages are so bad that the cell malfunctions and dies. But in about a million cells every day, the damage is weird enough that the cell, instead of dying, becomes immortal and hence, cancerous. Read on this website: Your genetic blueprint: Genome, chromosomes, DNA, and genes.

Our immune system has a way to figure out which of its cells are damaged. It sends some of its warriors—certain immune cells—to kill those cells. Now, just imagine: You are faced with a million new cancerous cells a day that need to be killed but your immunity is low enough that you cannot kill them all. Sadly, some of them thrive, grow into tumours and you can get cancer.

Low immunity could also be caused by several other reasons. There could be some genetic factors. Steroid medicines reduce the activity of your immune system. Some bone marrow or organ transplant patients are given immunosuppressant medications to improve the chances of acceptance of the outside tissues. Finally, pathogens such as the human immunodeficiency virus or HIV can cause low immunity.

Except when lowered by doctors as a part of some treatment, low immunity is not good.

Overactive Immune System

Just because low immunity is bad does not mean high immunity is good. It is desirable only if the immune system is functioning properly. A crude example: a faster car is better only if the roads are in good condition. Else, such a car going at high speed may end up in an accident.

If the immune system is hyperactive, it won’t cause problems provided the system is functioning correctly. Nature has provided the immune system with its checks and balances to prevent mishaps that could happen with strong immunity. However, if a hyperactive immune system malfunctions, it can cause two problems: Hypersensitivity and autoimmunity. To understand them, let me explain the concept of immune tolerance.

Immune Tolerance

As mentioned above, the immune system keeps accumulating a catalog of different enemy antigens and the correct responses to them. With time, the immune system keeps learning and getting better at repelling more and more types of enemies.

In the process though, some immune cells inadvertently gather the body’s own antigens (called self-antigens or auto-antigens) on their surfaces. Lo and behold, now you have an immune system, which thinks that your own antigens are enemy antigens. Those security guards think that you are an outsider because their verification catalog has wrongly listed your identity card among the enemy IDs.

In case you are wondering why nature is so error-prone, remember that living beings have come this far along the development tree because nature allows such trials and errors. That produces outcomes that are mostly worse but occasionally, superior to the existing life. Such living beings thrive better than their more flawed counterparts. And in the long term, over billions of iterations, the lifeforms that sustain are hardier than the earlier ones. Survival of the fittest, it is called. In fact, in extreme cases, such adaptations can happen over just one generation. Read on this website: African elephants and lessons for antibiotic resistance.

Thus, the process of immunity development is not perfect; in fact, none of the body processes are. This is potentially disastrous and if unchecked, the immune system can destroy your body’s own healthy tissues. That would be an autoimmune disease. But not yet; nature understands that the immune process is not faultless and so has developed checks to prevent a disaster from happening.

Central Immune Tolerance

The immune system has developed the first checkpoint called central tolerance. It kills the immune cells that carry the self-antigen records. This destruction is done right at the development stage of that immune cell itself. What a concept: it is called negative selection. The cells that can harm your own body are negatively selected (read: destroyed) just as they are formed.

Even then, three out of ten such cells escape this death trap and end up in the blood circulation. They can damage the body tissues.

Peripheral Immune Tolerance

The body has developed another checkpoint called peripheral tolerance. Here, the fully grown immune cells carrying the self-antigens are either eliminated or rendered harmless.

Unfortunately, some cells escape this second checkpoint, too. That is the start of an autoimmune condition.

The peripheral tolerance has another role. It is to prevent the immune system from overreacting to external antigens or stimuli. For example, the immune system has to be restrained in its response to allergens such as pollen. Similarly, it should not attack the gut bacteria that are symbiotically helpful to the body.

In contrast, the central tolerance is only to train the immune system to distinguish between self and non-self.

Immunity tolerance is different from immunity suppression or low immunity. Immunity tolerance is specific to an antigen, while low immunity is applicable to all antigens or enemies. This is vital to know because taking supplements that rectify low immunity is not going to cause autoimmunity or hypersensitivity.

Loss of Immune Tolerance

• If your body loses peripheral tolerance, you can develop hypersensitivity or allergies.
• If your body loses central as well as peripheral tolerance, it can develop an autoimmune disorder.
• If your body is fooled by certain pathogens into developing peripheral tolerance towards their antigens, your body cannot kill them ever.
• If your body is fooled by certain tumour cells to develop central and peripheral tolerance towards their antigens, they can grow unchecked and become full-fledged cancers.

Let us briefly see how our body can lose central and peripheral tolerance and develop autoimmunity.

How Various Autoimmune Conditions Develop

Science still does not know why and how our immune system loses some of its tolerance to auto-antigens. But we can piece together some possibilities based on a few associations and circumstantial evidence.

Genetics

Genes can predispose one to develop autoimmune conditions. But that does not mean one will end up with one. It needs environmental triggers to initiate the process. In a way, genes lay down the fertile ground but you need a seed to get a tree growing in it. The latter part is often an environmental trigger. Three points:

1. Family aggregation: Autoimmune diseases run in families.
2. Concordance rate: Genetically identical twins have 25% to 50% chances of getting the same autoimmune disease. Genetically non-identical fraternal twins have 2% to 8% chances of getting the same autoimmune disease.
3. Autoimmune gene: There is no single gene that causes all autoimmune disorders. Different genes are involved in different conditions. Plus, autoimmune conditions are considered to be multifactorial—caused by a combined effect of multiple factors.

Read on Johns Hopkins Medicine website: How do autoimmune diseases unfold?

Hormones

Women have a much higher chance of developing autoimmune conditions. But then, they also have a stronger immune response to vaccines and infections than men do. One guess is the role of female sex hormones such as estrogens in immune function.

Infections

Strep throat is a bacterial infection that can give you a sore throat. But an antigen on those bacteria resembles one on human heart cells. After the body clears strep throat infection, it retains that record. Later on, it may mistakenly think that our body’s heart cells are a new strep throat infection and attack them. This can lead to rheumatic heart disease, an autoimmune condition.

Stress

Stress is caused by the perception of a threat. This leads to a fight-or-flight response—a survival act. As the body gears up for those two possible activities, it tones down various body systems that are not essential for them. The immune system is one of them.

This is achieved by the release of stress hormones such as cortisol and norepinephrine. They suppress the immune system. However, in cases of acute or extreme stress, we get disruption of the immune system and modification in the release of signaling molecules called cytokines. This can lead to the triggering of autoimmune conditions. We know that individuals with stress-related disorders are:

1. More likely to be diagnosed with an autoimmune disease;
2. More likely to develop multiple autoimmune diseases; and
3. If they are undergoing treatment for stress-related disorders, the rate of developing autoimmune diseases is less than if they are not taking treatment.

Read on:
• WebMD: Severe Stress May Send Immune System Into Overdrive
• Harvard Medical School: Autoimmune disease and stress: Is there a link?

Nutrient Deficiencies

Many nutrient deficiencies are commonly linked to autoimmune disorders. We don’t know if the deficiencies can cause them but as discussed, autoimmune conditions are multifactorial. So a nutrient deficiency may trigger or worsen an autoimmune condition or prevent it from going into remission.

Deficiencies of nutrients such as vitamin A, B-vitamins, vitamin D, vitamin K₂, omega-3 oils, magnesium, iron, selenium, and zinc are associated with autoimmune conditions.

Damage Theory

If there is a normal body cell altered by medicine, a virus, or even sunlight, the immune system may confuse it to be a foreign substance. The virus-infected cells may cause the immune system to attack that body part. If a tendon or a joint is constantly stressed and comes in contact with blood, an immune response may be triggered causing an autoimmune condition.

Food Allergies

We discussed that if peripheral tolerance fails against external antigens, we get allergies and hypersensitivity. If it fails against self-antigens, we get autoimmunity. However, new evidence suggests that there is a connection between these two. That is, if someone develops allergies, the individual also is likely to develop autoimmune conditions.

There are many food additives in processed foods such as fat solvents and organic acids that can lead to autoimmune conditions.

Both of these suggest a possible pathway through a damaged digestive path leading to a condition called leaky gut syndrome.

Leaky Gut Syndrome

We know that 80% of our immune system is in the lining of our digestive system. The bacterial flora in the intestines called the gut microbiome is in a symbiotic relationship with our body. It produces many healthy chemicals that help in mood, metabolism, and immunity. Covering its functions is a vast topic in itself. Read on this website: Microbiome: The other ‘You’.

Our intestinal lining is made of cells tightly packed together with small holes in them. They allow only certain substances, such as digested food nutrients, to get into the bloodstream from the gut.

Due to various reasons, this gut lining gets damaged. This condition is called the leaky gut syndrome. The smaller holes become larger, allowing large and harmful substances to enter the blood circulation. Some of these substances are undigested food particles, bad bacteria, toxins, and big molecules such as gluten.

Once those substances enter the bloodstream, the immune system recognises them as new invaders. It starts generating inflammation to neutralise them. However, the leaky gut keeps ‘leaking’ such substances into the blood with every meal.

Over a period of time, the immune system catalogs such substances as ‘old’ invaders because it gets antigen records of them. As a result, the immune system attacks become stronger. But since the supply of these invaders is continuous from the leaky gut, the battle continues forever. At some point, the immune system starts malfunctioning and causes autoimmunity.

The exact mechanism is still not known, but many factors that trigger the leaky gut syndrome are also implicated in the development of autoimmune conditions. For example:

1. Vitamin D deficiency;
2. Acute stress;
3. Bacterial, fungal, viral infections;
4. Processed foods: Gluten, dairy, sugars, grains;
5. Exposure to toxins (chemicals, pesticides, air pollution, chemotherapy);
6. Antibiotics, acidity or heartburn medicines (PPIs and acid blockers), painkillers (NSAIDs).

So there is a suspicion that those factors lead to autoimmune conditions by causing the leaky gut syndrome.

Autoimmune Diseases and Their Locations

In a typical immune response, the body develops antibiodies, which are chemicals that attach to the invaders. These antibodies attach at the location of the antigens. Some antibodies deactivate the pathogen; some others mark the enemy and signal immune cells to come and destroy it.

In autoimmunity, these antibodies are chemicals released against auto-antigens. So they are called auto-antibodies. As you can guess, they would not be present in healthy individuals. But in individuals with autoimmunity, they exist in the bloodstream. Since an antibody is specific to an antigen, the presence of any specific auto-antigen preordains one particular autoimmune condition. Different auto-antigens cause different autoimmune conditions.

Some autoimmune conditions affect the whole body, while some others are localised to an organ. For example:

• Rheumatoid arthritis: the antibodies attach to the linings of the joints;
• Inflammatory bowel disease: the antibodies attach to the linings of the intestines;
• Systematic lupus erythematosus or SLE: the antibodies attach throughout the body;
• Myasthenia gravis: the antibodies attach to neuromuscular junctions;
• Multiple sclerosis: the antibodies attach to the linings of the nerve cells of brain and spinal cord; and
• Type 1 diabetes: the antibodies attach to insulin-producing beta cells in the pancreas.

Once the antibodies are attached to a cell, the immune system launches its attack on that cell, organ, or location, causing destruction.

So here we are: no single enemy, no single location, and no single mechanism. There is just too much variation in the causation and progression of different autoimmune conditions. So we are left with very limited options for their treatment.

Medical Management of Autoimmune Disorders

Normally, I don’t write about the medical management of any condition. That is because it is entirely the prerogative of your doctor. Similarly, you must consult with your doctor for the management of autoimmune conditions. But here, I want to give you some flavour for the options available in modern medicine for autoimmune conditions.

You will notice how limited the treatment choices are. So hopefully, when I mention supplements below, you will not have unreasonable expectations from them. Also, please check with your doctor before using any supplements.

1. Allopathy uses medicines that suppress the immune system (immunosuppressants) such as methotrexate, azathioprine, and mycophenolate. Since the immunity is artificially lowered, the patient has an increased risk of other infections and cancers. Choose your poison.
2. One may also use corticosteroids such as prednisone that reduce inflammation and immunity. They should be used for short periods but in some cases, one needs to use them indefinitely. Once again, the choice is of a lesser evil.
3. In some conditions, biologic agents such as infliximab and adalimumab are used. They reduce the actions of another inflammatory marker or chemical called TNF-alpha.
4. Some other medicines reduce the actions of white blood cells, which are involved in immune reactions.
5. Then, there is a procedure called plasma exchange where your blood is withdrawn, filtered to remove some abnormal proteins, and returned back.
6. Finally, a procedure called intravenous immune globulin is used where a purified extract of certain chemicals taken from the blood of a volunteer donor is injected into you. We don’t know why and how it works.

Supplementation Strategies for Autoimmune Disorders

As you may have noticed about the medical management, the non-invasive options are to reduce immunity (risky) and inflammation (not so risky). Therefore, it may be a good idea to be open to supplementation that also helps in inflammation control. I would not venture to try anything that lowers immunity. That should only be done under a doctor’s guidance.

My supplementation approach would be to:

1. Reduce inflammation caused by autoimmune conditions;
2. Help regularise the body’s immune system response to autoimmunity;
3. Give antioxidant support to the cell’s defence systems; and
4. Support the nervous system to respond to autoimmune condition demands.

Finally, I would urge everyone to keep in mind that autoimmune conditions are tenacious problems needing years of careful handling. So be prepared to persist with a very long-term and perhaps lifetime of use of supplementation. Since you are ready to use medicines for life, you might as well consider using supplements for life along with them.

Also, do not ignore dietary and lifestyle changes that go a long way in preventing the progression of the disease. I have provided many links at the end. Do read those articles.

Some supplements are useful for a specific autoimmune condition such as rheumatoid arthritis but not others. I have left out such details since there are just too many to mention.

Supplements to Reduce Inflammation

Chronic and excessive inflammation is a common thread in all autoimmune conditions. High inflammation creates a vicious circle by further revving up the immune system, which in turn creates more inflammation. Lowering inflammation also reduces organ degeneration.

Omega-3 oils: Anti-inflammatory. Reduces the risk of developing rheumatoid arthritis. Reduces the risk of inflammatory arthritis in some patients. 1000 mg of EPA+DHA a day. Read on this website: Omega–3 oils: A complete guide.

Curcumin: 5% extract of turmeric. Improves rheumatoid arthritis, multiple sclerosis, psoriasis, and inflammatory bowel disease. Reduces inflammatory cytokines (signaling chemicals released by immune cells that cause inflammation).

Supplements to Regulate Autoimmunity

Frankly, we don’t know how some nutrients can regulate autoimmunity. We just know they do.

Vitamin D: Patients of type 1 diabetes, lupus, inflammatory bowel disease, hypothyroidism, and multiple sclerosis have vitamin D deficiency. Vitamin D regulates many parts of autoimmune activities, such as specific gene expressions (certain genes becoming active) and inflammatory markers (toxic chemicals released in the body). Five years of use of vitamin D reduced the risk of developing autoimmune conditions by 30%. Take 2000 IU a day.

Selenium: Regulates immunity. Reduces thyroid auto-antibodies (helps autoimmune hypothyroidism). Several selenoproteins (proteins containing selenium) are antioxidants.

Zinc: Regulates the immune system. Zinc deficiency is found in many autoimmune conditions.

No one knows if selenium and zinc supplementation will improve autoimmune conditions as there are no such studies done. But they might be worth taking given the ancillary evidence.

The evidence about the benefits of iron and magnesium in autoimmune conditions is conflicting. They are helpful for normal immune function. Their low levels can reduce immunity. However, the use of magnesium and iron in autoimmune conditions is found to be detrimental. Avoid taking extra amounts.

Supplements to Reduce Oxidative Stress

Glutathione: A highly potent antioxidant that is the main component of the cell defence system against free radical damage to cell mitochondria. It stimulates or reduces the immune response to control inflammation, as needed.

Polyphenols: These are components of plants, such as green tea and grapes. They help relieve painful symptoms of various autoimmune diseases. Consider supplements of antioxidants such as EGCG (green tea) and resveratrol (grapes).

Coenzyme Q10 or CoQ10: Has a therapeutic role in autoimmune conditions, such as rheumatoid arthritis, multiple sclerosis, and type 1 diabetes. It protects cell mitochondria from oxidative damage. Read on this website: Coenzyme Q10: A complete guide.

Supplements to Support Nervous System

Your digestive system controls 80% of your immune system. It is also considered your second brain and has a big role in your nervous system. Plus, leaky gut syndrome is one big trigger for autoimmune conditions. So keeping your digestive nervous system (called the enteric nervous system) healthy will help autoimmune conditions.

Probiotics: These are foods or supplements containing healthy strains of gut bacteria. They help in autoimmune conditions through many mechanisms. Read here: Probiotic Applications in Autoimmune Diseases.

Prebiotics: These are dietary fibers in water-soluble and water-insoluble forms. They are foods for gut bacteria. Adequate amounts of them help keep the gut microbiome healthy.

B-vitamins: They are nutrients for the gut microbiome. They also regulate immune cell activity in the intestines. Read on this website: Everything you want to know about B–vitamins.

Omega-3 oils: They help maintain a balance between gut immunity and the gut microbiome. They maintain the intestinal wall integrity, affecting immune cells.

Siberian Ginseng: Advised for individuals who have chronic stress. It is an adaptogen, which is a compound that helps reduce stress response. Reducing stress through mindfulness and yoga is the lifestyle modification. But if one cannot reduce stress by behaviour modification, taking adaptogens is an indirect way: reduce stress response, if not stress.

Ashwagandha: An adaptogen, used for thousands of years in Ayurveda, the Indian medicinal science. For individuals who have chronic, high stress.

To Read More

• MSD Manual: Autoimmune Disorders
• WebMD: What Are Autoimmune Disorders?
• Antioxidants Journal: Nutraceuticals against Oxidative Stress in Autoimmune Disorders
• Johns Hopkins Medicine: Autoimmune Disease: Why Is My Immune System Attacking Itself?
• Children’s Hospital of Philadelphia: What Happens When the Immune System Does Not Work Properly?
• Regeneration Health Medical Center: 5 Supplements For Your Autoimmune Disease
• The CSR Journal: 10 Steps To Reverse Autoimmune Diseases
• WebMD: Life with an Autoimmune Disease
• Immunopaedia.org: Central & Peripheral Tolerance
• NewScientist: Autoimmune Diseases May Be Side Effect of a Strong Immune System
• Pharmacy Times: Omega-3 Fatty Acids Promote Gut Health

First published on: 22nd May 2022
Image credit: Marcus Aurelius from Pexels
Last updated on: 26th May 2022