Page 54 - IDF Journal 2023

IDF – Webinar Series IDF News – Spring 2023
Addressing the Missing Link
Functional Medicine Approach to Autoimmune Conditions
Dr Kapil Chawla
Functional medicine versus conventional medicine
Conventional medicine is focussed on recognising symptoms to identify an illness and develop treatment plans with appropriate pharmaceuticals to address the symptoms.
Functional medicine however focuses
on the root cause of the symptoms. Symptoms are recognised as clues to the cause or effect of the underlying imbalances which are addressed upstream to correct the imbalance. Functional medicine recognises the uniqueness of individual physiological, biochemical and genetic makeup, focussing on the mechanism and causes rather than an illness/disease label; seeking wellness and not just absence of disease.
Key concepts in managing autoimmunity
1. The triad of autoimmunity
2. Antigen processing at the barriers in general and specifically via the aero- digestive tract
3. Reducing antigenic triggers
4. Facilitating a healthy diverse microbiome
Autoimmunity is an incurable condition. The clinical goal is to improve individual’s diet, nutritional status and lifestyle to support health and function. We know from experience of using disease modifying anti-rheumatic drugs (DMARDs), that sustained clinical remission at 3-5 year follow up remains only in 11% of patients. Drug inefficacy, serious life threatening infections with increased risk of cancer, and anti-drug antibodies are some of
the factors limiting the sustained use of Biologics to slow the disease progression.
Obstacles in diagnosing and managing autoimmune diseases
Symptoms cover many specialities and can affect all body organs. Specialists are usually unaware of advances in treatment outside their own speciality area. Initial symptoms are often intermittent and non-specific until the disease becomes acute. Research is generally disease- specific and limited to a particular cytokine targeted drug model. Functional medicine approach can be viewed as a specialist Inflammologist in a very simplistic way.
The triad of autoimmunity
Trigger by a foreign antigen, genetic predisposition due to varied adaptive immune response, and lack of mucosal tolerance i.e. barrier disruption are the three major areas contributing to the onset of autoimmunity. This has been formally established by the works of Alesio Fasano, Professor of Paediatric Gastroenterology at the Harvard Medical School through his work on coeliac disease and discovery of tight junction protein, zonulin.
Healthy immunity across the barriers
is detective and defensive, internally regulated, restorative and tolerant. This leads to immune tolerance of foreign beneficial antigens and clearance of unwanted potentially harmful ones.
Modern lifestyle facilitates innumerable triggers for barrier disruption
Proinflammatory diet, uses of
pesticides, antibiotics use in livestock, herbicides, fungicides, hormones in livestock, genetically modified foods,
use of antibiotics and other synthetic medications, environmental xenobiotics, stress, smoking etc. are some of the daily triggers which a modern life brings to us. All of these directly affect our intestinal microbiota which leads to loss of immune tolerance, intestinal permeability and
Small Intestine Bacterial Overgrowth (SIBO) creating disruption of barriers through which we normally interact
with our environment. This leads to exposure of unprocessed foreign antigens inciting immune response and triggering autoimmunity through at least 17 different mechanisms which includes molecular mimicry.
Complex web of triggers and immune interactions
There is enough evidence to support that most chronic diseases including autoimmunity have non-linear causation. There are multiple factors that interplay in a complex manner to produce a variety of seemingly unrelated symptoms. It is important to understand this and apply
a systems biology approach to uncover and correct the underlying imbalance to produce lasting remissions.
Tending the entire garden
It is imperative to realise that, to stay healthy, we need to understand the health of the environment and other living beings (plants, microorganisms and animals) that inhabit this planet. Our survival is directly dependent on their health as we are not alone. However, to maintain our unique individuality we must interact through healthy barriers. This involves immune tolerance, reduced exposure to antigen substances for example by avoiding use of proton pump inhibitors (PPI) in the long term, identifying and treating infections, removing and reducing exposure to chemical triggers, promoting microbial diversity, and improving stress resilience.
Dr Kapil Chawla
MBBS MD MRCGP FRACGP IFMCP
HCA Elstree, The Waterfront, Elstree WD6 3BS
W: www.drkapilchawla.co.uk
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