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September 3, 2018
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B Vitamins: How Much Is Too Much?
September 10, 2018

How Accurate is Autoimmune Screening?

screening-for-autoimmune-disease

Autoimmune screening might not be something that you have considered often, but I have to tell you that it is super important. Based on a recent question that I received, I wanted to perform a deep dive into this topic to help give you a better sense of what it is all about, and how it can work best for you. Let’s discuss autoimmune screening today.

screening-for-autoimmune-disease

A Question From A Reader

As I mentioned, this all started with a question that I received from a reader. I always like to make note of the fact that I love to see your questions. So, please, keep them coming. Here is what today’s question had to say:

“Hi Dr. C, I have a low thyroid and never lost weight. My doctor did multiple autoimmune reactivity screens to see if I have any other autoimmune diseases, it looks like I have lupus, leaky brain, and possibly other autoimmune diseases. I’m completely freaked out, where do I start?” – Amy

Amy, and for anyone else who might be feeling this same way, there are two things that I want to discuss:

  1. Diagnosing autoimmune diseases – what we know, what we do not know, and what are some of the things you might see floating around of what folks are trying to do about it.
  2. Second, I want to address your primary concern about losing weight with hypothyroidism.

Diagnosing Autoimmune Diseases

The Good

Thankfully, where we are in medicine right now is a good place to be. Nowadays, we are much more aware of autoimmune disease than we have ever been in the past. People think about it a lot, and it might even be close to being a household term. It’s gaining loads of attention.

Key Insight: Therefore, doctors are way less apt to ignore autoimmune disease these days (or, at the very least, less able to rule it out completely without knowing more). That is a great development for a lot of people who need the help.

The other great thing that has happened is that people are more aware that their lifestyle habits, their diet, their stress load (1), their activity levels all can have a huge impact upon their immune system. This effects:

  • Whether or not they get these diseases
  • If they progress or not
  • How they can get better

Bottom Line: People have a lot of control over these variables, which is what is awesome about where we are currently with the state of autoimmune disease.

The Not-So-Good

At the very same time, and in my honest opinion, many practitioners are using these terms way too lightly. Instead, the term “autoimmune disease” gets passed around without being given the same comprehensive vetting.

For starters, I want to talk about how not all disease or symptoms are really about autoimmunity in their origin. Many are, but it is my personal belief that there are plenty which went too far in the other direction.

In fact, I did a very quick Google search for “autoimmune disease list,” and the first thing that popped up listed a large number of diseases that are simply not autoimmune1. This list included:

  • Endometriosis
  • Eosinophilic esophagitis
  • Fibromyalgia
  • Lyme disease
  • Narcolepsy
  • PANDAS
  • Pernicious anemia
  • Restless leg syndrome
  • Subacute bacterial endocarditis

Bottom Line: You could make an argument to consider immune factors for each of the above, but they are most certainly not driven by the immune system directly attacking itself. That is the definition of an autoimmune disease that I want to make clear to you today.

The Case of Symptom Lists

Before we begin, how often do you think about the positive changes you can make in your day-to-day life? Here’s a great place to start to get your mornings – and your days – back on track…

Daily Reset Packs - Complete Nutrition - Dr. Alan Christianson

This is another thing that I believe causes a lot of unnecessary alarm for people who are searching for answers. I even did a quick consult with “Dr. Google” to look up some “autoimmune symptoms.”

On about ten different sites, I saw the same list verbatim. These lists discussed:

  • Joint or muscle pain
  • Weight loss
  • Insomnia (2)
  • Heat intolerance
  • Rashes or hives
  • Difficult focusing
  • Feeling tired or fatigued (3)
  • Easy weight gain
  • Hair loss
  • Abdominal pain
  • Dry eyes, mouth, or skin
  • Numbness or tingling in hands or feet
  • Multiple miscarriages or blood clots

What I want to make clear is that these are all super important symptoms. They are all things that should be addressed and should be taken care of, for the overall sake of your good health.

In that list, though, there are things which are wildly different from one another. Recurrent miscarriages, for example, or numbness and tingling in the body. Those are distinctly different from brain fog or fatigue.

The important thing to realize is that some of these symptoms are things that happen to perfectly healthy people, for no known significance whatsoever. Sadly, our bodies, even when things are healthy and working a-okay, are known to make mistakes.

Key Insight: Our bodies do not work perfectly 24/7, 365. Our energy, both mental or physical, is not static – it changes, as do plenty of things in our body, for no reason to be greatly alarmed.

What I do not want to do today is make people struggling with autoimmune feel like they are not suffering, or that their condition is invalid. Instead, I want you to know that it is normal to not always feel perfect. That is just how things work because our bodies are naturally “limited.”

The other part about these symptoms that I want to help explain for you is that while they can be caused by autoimmunity, there is almost no shortage to things that are not autoimmunity that could also be causing them (4).

autoimmune-disease-symptoms

In fact, it does people a great disservice to look at this sort of list and to suggest that someone definitely has an autoimmune disease if they have some or all of these symptoms. Truth be told, this is a really common pitfall that I wish so many people did not have to go through.

Bottom Line: A clear diagnosis is essential to your health. While a doctor might tell you some things to treat autoimmune symptoms, and you might get better, we can also chalk this up to plain luck. Instead, I think it is crucial to officially diagnose someone with a condition before telling them what to do, so as not to deprive them of making headway earlier (and feeling better sooner – which we all deserve).

list-of-autoimmune-diseases-and-their-symptoms

Common Pitfall: Blood Tests

Doctors will often do tests to work through autoimmune diseases. I will talk more about those later. One difficulty, though, comes from blood tests. When it comes to autoimmunity, blood tests have very high rates of false positives (when they are done without full context).

Bottom Line: Blood tests do not make for good screening tests. If you have them on their own, they are simply ineffective in suggesting whether or not someone has an autoimmune disease. What you need, more than anything else, is context to correctly diagnose.

Understanding ANAs

In order to illustrate this point, I wanted to keep in mind the concerned reader who asked this question in the first place: Amy. She had mentioned having signs of possible autoimmunity and hypothyroidism, along with lupus.

After updating myself on the latest literature concerning this subject, here is what I found: The best-used autoimmune test, with the most comprehensive data points by far, is known as an anti-nuclear antibody screen (ANA).

In Amy’s exact situation, if we know someone is hypothyroid, we do an ANA test on them and from that ANA test we think they have lupus – that false positive rate is going to be somewhere in the neighborhood of 50 – 100%2.

What that means is that if we had 100 people, just like Amy, take this test, and all of them who were hypothyroid had tested positively for lupus – at the very least, half of them do not have lupus. In many cases, none of them would have lupus.

Bottom Line: This is all to say that the ANA test is not a valid instrument to suggest that you have lupus beyond a shadow of a doubt.

Keep in mind that this is about one test in particular. Amy also had mentioned suffering from leaky brain and possibly other autoimmune diseases. The issue that I had talked about previously, with the false positive effect suggesting that you have a problem when you really do not have a problem at all.

Key Insight: The known rate for false positives in autoimmunity tests is rarely less than 50%. In many cases, it hovers around the 60 – 70% range. It takes a lot of distinction beyond a single blood test and some symptoms to diagnose autoimmune disease.

Screening Panels

I looked into the panel that Amy had done, which are readily available for most, and while they are designed to be thorough, the drawback is that when you check a lot of things at once you are going to have a higher rate (a higher number) of false positives appear.

There are tests which will consider 20 – 30 autoimmune antibodies, many of which are unrelated to one another. Some of these are tied to known diseases, but many of which are simply speculative. They are not tied to any known human diseases at all. These include:

  • Parietal Cell
  • Intrinsic Factor
  • ASCA + ANCA
  • Tropomyosin
  • 21 Hydroxylase (Adrenal Cortex)
  • Myocardial Peptide
  • Alpha-Myosin
  • Phospholipid
  • Platelet Glycoprotein
  • Ovary/Testis
  • Fibulin
  • Collagen Complex
  • Arthritic Peptide
  • Osteocyte
  • Cytochrome P450 (Hepatocyte)
  • Insulin + Islet Cell Antigen
  • Glutamic Acid Decarboxylase
  • Myelin Basic Protein
  • Asialoganglioside
  • Alpha + Beta Tubulin
  • Cerebellar
  • Synapsin

Bottom Line: As I mentioned before, for well-studied antibody tests like the ANA, false positive rates commonly exceed 60%. If a perfectly healthy person is tested for 22 antibodies, the odds are that 13 will come back positive by random chance.

How Would You Diagnose Autoimmune Disease?

autoimmune-screen-panel

Endocrine Conditions

The truth is that this subject matter falls under certain medical specialties. Those who are in the naturopathic endocrinology space are well-versed in dealing with autoimmune thyroid disease. We can diagnose things like:

  • Addison’s disease
  • Type 2 diabetes

Bottom Line: Endocrinologists and those who have a more naturopathic, holistic, integrative type of training can do a good job of both diagnosing and working to find safe treatment options to help secure your health.

Neurological Conditions

If we think about autoimmune neurological diseases, that would fall under the expertise of neurologists. These are conditions such as:

  • Multiple sclerosis
  • Myasthenia Gravis
  • Guillain Barre Syndrome

Bottom Line: These are some of the things that a neurologist can do a good job of diagnosing.

Rheumatologic Conditions

These fall under the guidance of a rheumatologist and can include some of the conditions like:

  • Lupus
  • Rheumatoid arthritis
  • Scleroderma

Bottom Line: What is different about a specialist is that they are going to consider your family history, your symptoms, your test values, and even some imaging tests. Anything less than that, honestly, is not a real diagnosis of autoimmune disease. It needs to be comprehensive.

If your specialist is trained in integrative and functional medicine, then they may also talk about finding your root causes. Here’s a place you might like to start…

FREE - Optimal Thyroid Values Program - Dr. Alan Christianson

Hypothyroidism & Weight Loss

So, let’s circle back to Amy’s original question: Why are you unable to lose weight with hypothyroidism?

The short answer is based on what we have seen at Integrative Health. When someone goes from hypothyroidism to optimal thyroid function, about 20% of them lose weight just like that (the weight that they had gained during a state of hypothyroidism).

Even when your thyroid is causing the weight gain, reversing your thyroid’s performance alone is not always the key to reversing the weight gain. In my experience, that remaining 80% is at least now able to lose weight.

Bottom Line: Thyroid health and weight loss is a different path for some, the kind that might deviate from traditional weight loss strategies. The first thing, though, is getting back to where your thyroid feels its best – and going from there.

infographic_autoimmune

Regain Your Health, Take Back Your Life

I can safely say that all of our doctors at Integrative Health do a great job of helping people dial in their thyroid while helping folks gain a clearer sense of what they can do to take off that weight and get back to where they belong.

What it comes down to, though, is getting your dosing perfect, getting the right nutrients to support your thyroid (and not block it), getting foods that fit your immune system, detoxing your body, dialing in your rhythms, and healing your digestion. When you are healthy, weight loss can happen – and it is best done as a project, and not a lifestyle.

If you are concerned about the state of your thyroid, and what you can do to manage it today, I would heartily recommend considering taking the Thyroid Quiz today (5). It can help you unlock so much about your health, I know you will be better for it.

1. https://www.aarda.org/diseaselist/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625361/

dr-c-pic

Dr. Alan Glen Christianson (Dr. C) is a Naturopathic Endocrinologist and the author of The NY Times bestselling Adrenal Reset Diet.

Dr. C’s gift for figuring out what really works has helped hundreds of thousands of people reverse thyroid disease, lose weight, and regain energy. Learn more about the surprising story that started his quest.

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