Authored by Dr. Barrett

The figure above highlights a few hypothesized mechanisms for developing long-COVID. Today we are going to talk about the relationship between autoimmunity and COVID-19.

Autoimmune disease develops when the immune system starts attacking your own tissues. In addition to genetic factors, environmental triggers including viruses, bacteria and other infectious agents play a major role in the development of autoimmune diseases. There are several mechanisms behind these triggers that include but are not limited to molecular mimicry, bystander activation and epitope spreading. In an oversimplified nutshell there can be cases of mistaken identity (molecular mimicry), our immune system getting overexcited (bystander activation), and chronic inflammation (epitope spreading). One major hypothesis regarding COVID-19  and autoimmune disease is that SARS-CoV-2 aggravates the immune system via molecular mimicry and bystander activation. 

There are several ways that autoimmune disease and COVID-19 are interrelated. COVID-19 may trigger new onset of autoimmune disease. Conversely, people with existing autoimmune disease may be at risk for complications from a COVID-19 infection. People who experience ‘long COVID’ have higher incidence of blood markers for autoimmune disease. 

COVID-19 may trigger the development of autoimmune diseases. One study looked at patients hospitalized with COVID-19 and measured their levels of autoantibodies. Autoantibodies are antibodies that attack our own tissues. They found that approximately 50% of patients hospitalized with COVID-19 generated autoantibodies compared to just 15% of non infected individuals. This indicates that SARS-CoV-2 causes development of new autoantibodies which correlates with an autoimmune response. (1)

Patients with autoimmune diseases specifically rheumatic, IBD, and multiple sclerosis appear to be more vulnerable to severe outcomes from COVID-19 infections. One important note is that all of these conditions increase the risk of cardiovascular disease. In many of the studies, once cardiovascular disease is taken into account, the association between autoimmune disease and severe outcomes from COVID-19 isn’t as statistically significant. In a nutshell, it could be not so much the autoimmune piece that increased the risk but the cardiovascular health of the patient (2). We need more research to understand why patients with autoimmune disease may be at a higher risk for complications and severe outcomes from COVID-19.

Patients with long-COVID syndrome exhibit immune characteristics that include higher predisposition to autoimmunity. ANA is a blood marker used to diagnose autoimmune diseases. One study looked at patients who had long-COVID for one year and found a positive ANA in a significant number of patients compared to controls (3). Interestingly these patients also had a poorer antibody response to SARS-CoV-2 and more chronic inflammation. 

It's important to note that while there is evidence suggesting a connection between COVID-19 and autoimmune disease, more research is needed to fully understand the mechanisms behind this association. 

In naturopathic medicine we work to reduce triggers to the immune system, lower systemic inflammation and bring more balance to an overactive immune system. We use a variety of tools including but not limited to nutrition, botanical medicine, microbiome support, mind body medicine, hormone balancing, lifestyle medicine and targeted supplementation. 


References: 

1. Chang SE, Feng A, Meng W, Apostolidis SA, Mack E, Artandi M, Barman L, Bennett K, Chakraborty S, Chang I, Cheung P, Chinthrajah S, Dhingra S, Do E, Finck A, Gaano A, Geßner R, Giannini HM, Gonzalez J, Greib S, Gündisch M, Hsu AR, Kuo A, Manohar M, Mao R, Neeli I, Neubauer A, Oniyide O, Powell AE, Puri R, Renz H, Schapiro J, Weidenbacher PA, Wittman R, Ahuja N, Chung HR, Jagannathan P, James JA, Kim PS, Meyer NJ, Nadeau KC, Radic M, Robinson WH, Singh U, Wang TT, Wherry EJ, Skevaki C, Luning Prak ET, Utz PJ. New-onset IgG autoantibodies in hospitalized patients with COVID-19. Nat Commun. 2021 Sep 14;12(1):5417. doi: 10.1038/s41467-021-25509-3. PMID: 34521836; PMCID: PMC8440763.
2. Winchester N, Calabrese C, Calabrese LH. The Intersection of COVID-19 and Autoimmunity: What is Our Current Understanding? Pathog Immun. 2021 Mar 8;6(1):31-54. doi: 10.20411/pai.v6i1.417. PMID: 33969248; PMCID: PMC8097827.
3. García-Abellán J, Fernández M, Padilla S, García JA, Agulló V, Lozano V, Ena N, García-Sánchez L, Gutiérrez F, Masiá M. Immunologic phenotype of patients with long-COVID syndrome of 1-year duration. Front Immunol. 2022 Aug 24;13:920627. doi: 10.3389/fimmu.2022.920627. PMID: 36090973; PMCID: PMC9451924.
4. Liu Y, Sawalha AH, Lu Q. COVID-19 and autoimmune diseases. Curr Opin Rheumatol. 2021 Mar 1;33(2):155-162. doi: 10.1097/BOR.0000000000000776. PMID: 33332890; PMCID: PMC7880581.
5. Castanares-Zapatero D, Chalon P, Kohn L, Dauvrin M, Detollenaere J, Maertens de Noordhout C, Primus-de Jong C, Cleemput I, Van den Heede K. Pathophysiology and mechanism of long COVID: a comprehensive review. Ann Med. 2022 Dec;54(1):1473-1487. doi: 10.1080/07853890.2022.2076901. PMID: 35594336; PMCID: PMC9132392.

This blog has moved! Check out Dr. Barrett's blog: 
​https://www.wellnessminneapolis.com/drbarrettblog/autoimmune-disease-series-episode-4-hormones 

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Authored by Dr. Barrett

This blog has moved! Check out Dr. Barrett's blog post here. 

Authored by Dr. Barrett
​
This is the second article in a series exploring autoimmune disease with a holistic lens. Don’t miss upcoming articles diving into chronic infections, nutrition, hormones, environmental medicine and mind body medicine.

This blog has moved! Check out Dr. Barrett's blog here. 

Authored by Dr. Barrett

This is the first article in a series exploring autoimmune disease with a holistic lens. Don’t miss upcoming articles diving into chronic infections, nutrition, hormones, environmental medicine and mind body medicine.

This blog has moved! Check out Dr. Barrett's blog post here. 

Authored by Dr. Wilder

When it comes to searching for the root cause of or factors that contribute to heart disease, it’s imperative that you look outside of the heart.

If you’re one of the 14 million individuals living with Hashimoto’s thyroiditis1, the time is now to start thinking about how to prevent heart disease.

Hashimoto’s thyroiditis is an autoimmune condition where your own body's immune system cells attack your thyroid gland. Over time, the thyroid becomes damaged and its ability to release hormones decreases, giving you symptoms of under-active thyroid (hypothyroid). You receive a diagnosis of Hashimoto’s by measuring specific antibodies (anti-thyroid peroxidase antibody and anti-thyroglobulin antibody) in the blood, and if they come back elevated it's a good indication that you have autoimmunity to your thyroid gland.

Many research studies have shown that hypothyroidism leads to an increase in risk of heart disease5,7, but it’s now being researched how autoimmune thyroid conditions may also be a risk factor for atherosclerosis (build up of plaque on artery walls) and ischemic heart disease (heart not getting enough oxygen).
 
A clinical finding of Hashimoto’s thyroiditis that is not always talked about is the chronic low-grade inflammation that it causes3. The persistent antibodies that are being produced by your immune system orchestrate the recruitment of white blood cells to deal with the antibodies. These white blood cells release chemical messengers that trigger this chronic inflammation4,5.
 
The activation of these inflammatory messengers causes an increase in the amount of oxidative stress that is put on your body, which not only reduces your own body's antioxidant storage, but can lead to damage of your blood vessel lining2. When your blood vessel lining gets damaged, its cholesterol’s job to come in and patch that up causing what is widely known as plaque.
 
You can assess your levels of inflammation and risk of heart disease by having your doctor run a high-sensitivity CRP (hs-CRP) or serum homocysteine lab. An imaging test that can be helpful is a carotid intima media thickness test6. This non-invasive ultrasound could be helpful in determining your heart disease risk in subclinical hypothyroid or Hashimoto’s by seeing how much plaque is built up in your arteries.
 
So what are some things you can you do to reduce your risk of heart disease?

1. Incorporate an anti-inflammatory diet this is high in colorful vegetables, quality protein sources, and good fats. This can help to combat the inflammation that is being caused by the antibodies. It will not only help protect the blood vessel lining, but can protect the thyroid gland from further damage.
2. Balance your immune system.
3. Increase your antioxidant stores by eating dark berries, or supplementing with Hawthorne to quench the free radicals being caused by the antibodies.

 
 
References:

1. Hashimoto's Thyroiditis: Information for Patients page. The American Association of Clinical Endocrinologists (AACE) Web site. Available at: http://www.aace.com/pub/thyroidbrochures/pdfs/Hashimoto.pdf. 2005. Accessed April 27, 2010.
2. Taddei S, et al. Low-Grade Systemic Inflammation Causes Endothelial Dysfunction in Patients with Hashimoto’s Thyroiditis. J of Clin Endocrinology & Metabolism. 2006; 91(12):5076-5082.
3. Libby, Peter. Inflammatory Mechanisms: The Molecular Basis of Inflammation and Disease. Nutrition Reviews. 2007; 65(12):S140-146.
4. Nanda N, Bobby Z, Hamide A. Inflammation and oxidative stress in hypothyroids: additive effects on cardiovascular risk. Indian Journal Of Physiology And Pharmacology [serial online]. October 2011;55(4):351-356.
5. Isgüven P, et al. Effects of Thyroid autoimmunity on Early Atherosclerosis in Euthyroid girls with Hashimoto’s Thryroiditis. J Clin Res Pediatr Endocrinol 2016;8(2):150-156.
6. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta- analysis. Circulation 2007;115:459-467.
7. http://www.ncbi.nlm.nih.gov/pubmed/15249698

 

Authored by Dr. Pharis 

Naturopathic medicine is a comprehensive system of care that combines our modern understanding of health and disease with traditional, natural healing techniques. It is aimed at improving health and addressing illness in people of all ages, with a focus on prevention and whole-patient care. In addition to prevention, the true essence of naturopathic medicine is to seek out and treat the underlying cause of disease rather than focus solely on symptomatic treatment. Naturopathic doctors are trained to practice evidence-based medicine while simultaneously adhering to its underlying philosophy. The practice of naturopathic medicine is defined by its principles rather than its methods or modalities. Where methods are chosen upon the basis of patient individuality, principles act as the cornerstone guidelines of any naturopathic practice. Naturopathic doctors work to restore balance in a gentle and effective way, minimizing the potential for side effects. Above all, naturopathic medicine honors the body’s innate wisdom to heal.
 
Principles of Naturopathic Medicine

• First Do No Harm: Naturopathic doctors follow three guidelines to ensure their patient’s safety:
  1) Utilize methods and medicinal substances which minimize the risk of harmful side effects, using the least force necessary to diagnose and treat;
  2) Avoid when possible the harmful suppression of symptoms;
  3) Acknowledge, respect, and work with the individual’s self-healing process.

 

• The Healing Power of Nature: Naturopathic medicine recognizes an inherent self-healing process in each person. Naturopathic doctors work to support this by recognizing and removing obstacles to healing and recovery, and to facilitate and augment this inherent self-healing process.

 

• Identify and Treat the Cause: Naturopathic doctors seek to identify and remove the underlying causes of illness. They understand the importance of treating the root cause of disease, rather than suppressing symptoms.

 

• Treat the Whole Person: Naturopathic doctors take the time to understand each person’s unique physical, mental, emotional, genetic, environmental, and social factors that contribute to one’s state of health. This allows naturopathic doctors to tailor individual treatment protocols to each patient.

 

• Doctor as Teacher: Naturopathic doctors educate their patients and encourage self-responsibility for health. They also recognize and employ the therapeutic potential of the doctor-patient relationship.

 

• Prevention is the Best Medicine: Naturopathic doctors emphasize the prevention of disease by assessing risk factors, and recommending appropriate interventions to maintain health and prevent illness.

 
Naturopathic Doctor Education and Training
Licensed naturopathic doctors have scientific medical training and are required to complete an undergraduate degree as well as an intensive four-year medical program at an accredited institution. Naturopathic medical students receive training in the same basic sciences as conventional medical students with additional coursework in holistic and nontoxic approaches to therapy. The curriculum includes in-depth training in diagnosis and treatment of disease, with an emphasis on disease prevention and wellness optimization.
 
Graduates from naturopathic medical schools are additionally required to pass a comprehensive Naturopathic Physicians Licensing Exam (NPLEX). Successful completion of this exam allows naturopathic doctors to become licensed or registered in the jurisdiction which they practice. There are currently 19 states that have laws regulating naturopathic physicians, including Minnesota.
 
Naturopathic doctors are trained in primary care and are experts in the field of natural medicine.  Their training prepares them to treat all aspects of family health and wellness, from pediatrics to geriatrics. Many individuals choose to further specialize by taking additional continuing education coursework or completing a residency program. Naturopathic doctors use a holistic, individualized approach to assessment and treatment with a focus on prevention and self-care. Therapies used by naturopathic doctors are tailored to meet individual needs, factoring in the physical, social, emotional, and spiritual aspects of each patient. Depending on the state, therapeutic modalities used by a naturopathic doctor may include any of the following:

* Not currently practiced in Minnesota

Naturopathic doctors work in conjunction with all other branches of medical science, and will refer patients to other practitioners for diagnosis or treatment on a case-by-case basis.
 

Working with a Naturopathic Doctor
At Wellness Minneapolis our team of Naturopathic Doctors pride themselves on delivering individualized healthcare. We ensure each patient leaves feeling listened to, cared for, and treated as a unique individual. Our providers specialize in a variety of health conditions along with general wellness and preventative medicine. Initial office visits last between 75-90 minutes, allowing for optimal time to learn about your health concerns and goals, health history, and to provide a unique treatment plan. We value the extended amount of time we spend with our patients, and find it an essential component to get to the root cause of one's health concerns. To assist in the diagnostic process both conventional and/or functional lab work may be ordered. A follow-up visit is typically scheduled between 4-6 weeks after the initial visit to reassess symptoms, check progress with initial treatment recommendations, and to review any labs that were ordered. Subsequent visits are scheduled as needed and dependent upon the goals and needs of each individual.

If you are unsure if our model of care is the right fit for you, call our office to schedule a free 15-minute phone call with one of our providers. We look forward to serving you and your loved ones, and assisting you on your journey to health.

Authored by Monica Mack, CHC ​

You may have just stepped out of your doctor’s office with the recommendation that you should begin an Elimination Diet. Or, if you are like me, you are sick of lingering unwelcome symptoms, and have decided to try going through the diet yourself, to see what insights it can reveal about your health. 

Regardless of how you got here - even though it is a temporary diet plan with a multitude of benefits - its strictness can be intimidating. I’m here to share what I learned through my experience on an Elimination Diet, with the hope that it will leave you feeling more prepared and confident as you embark on this journey. You are not going at this alone!

The Elimination Diet is used to uncover food intolerances that can be at the root of a variety of health conditions such as allergies, gut imbalances, skin issues, and inflammation; the food we eat can even effect our mood and mental health. Spending three weeks removing all foods that have a track record of causing these issues: gluten, dairy, soy, and caffeine to name a few, gives the body time to reset and begin the healing process. From there, these foods are slowly reintroduced, one by one, and the culprit(s) can be identified.
 
As we all know, knowledge is power. With this information at your disposal you can not only relieve the symptoms of your primary health concern - the one that brought you down this path in the first place - but you can also look forward to increased energy, relieved brain fog, reduced inflammation, a boost to your immune system, and a solid step towards jump-starting clean eating and removing any undesirable processed foods from your diet.

But, perhaps even more important to stress, is that you will have made a huge stride in proactively improving your own health and wellbeing. You will have made new discoveries about yourself; what it means to focus on how the foods you eat make you feel, what foods make you feel good and not so good, and about being more mindful of what you are putting in your body.

Once you identify the foods that work best for your body, you can create a custom meal plan tailored just for you. So consider this challenging endeavor an act of self-care and self-responsibility; you are honoring your body by discovering the most beneficial way of eating that nourishes you, fills you up, and gives you energy to pursue what you want out of life.
So first, give yourself a big hug  for taking the initiative to make a change in your life for the better by focusing on healing and improving your health. Next, I’d like to give you five tips to make the next few weeks as illuminating, encouraging, and as painless as possible:

According to the American Thyroid Association more than 12% of the US population will experience thyroid dysfunction in their lifetime.  The thyroid is a gland that sits in our lower neck and releases thyroid hormones, which activate genes in virtually all cells of the body. These hormones increase functional activity, which can be simplified to say they regulate our metabolism. There are many types of thyroid dysfunction. This article will focus on hypothyroidism (under functioning thyroid gland), specifically the most common type of hypothyroidism: Hashimoto’s.
 
The technical name for Hashimoto’s is chronic autoimmune (lymphocytic) thyroiditis. Hashimoto’s is a condition in which the immune system attacks and destroys the thyroid gland. This leads to a gradual loss of thyroid function over time. Hashimoto’s is seven times more common in women than in men. Most often patients with Hashimoto’s experience the typical symptoms of hypothyroidism which can include: weight gain, fatigue, cold intolerance, constipation, hair loss, depression, heavy periods, muscle aches, poor concentration, dry skin and more. Some patients experience Hashitoxicosis, which happens when the immune system attack on the thyroid causes an excessive amount of thyroid hormone to be released for days or weeks. This excess hormone leads to hyperthyroid symptoms such as sweating, insomnia, palpitations, etc. This is often followed by a period of hypothyroid symptoms, which can leave the patient feeling like they are on a roller coaster!
 
What causes Hashimoto’s?
As with any autoimmune disease we don’t know all of the triggers that exist but here is a “short” list.
Postpartum: Pregnancy naturally causes a shift in the mother’s immune system to allow for the fetus to develop inside her body. This immune shift can trigger Hashimoto’s postpartum as the mother’s immune system tries to return to “normal”. It can be a transient or a permanent condition.

Iodine: Mild iodine deficiency is associated with a lower prevalence of Hashimoto’s disease and hypothyroidism while excessive iodine intake is associated with a higher prevalence.

Molecular mimicry: This is a critical piece to autoimmune disease. The basic concept is that your body mounts an immune response to something (pollen, food, virus, bacteria, etc.) and then those immune cells become confused and start attacking your tissues. With Hashimoto’s this happens frequently with gluten. I see many patients whose antibodies drop significantly upon going gluten-free. It also happens with certain GI bacteria especially Yersinia. Epstein Barr Virus has been implicated with triggering Hashimoto’s. On another gluten note, patients with Hashimoto’s are at an increased risk for celiac disease!

Intestinal permeability: This goes hand in hand with molecular mimicry. Intestinal permeability is often called “leaky gut”.  Our GI tract is technically outside of our body, you could eat a penny and it would pass right through your GI and out into the stool. Your body determines what is brought in through the GI tract in to your blood stream. When there is a breakdown in this process and larger particles are allowed in to the blood we call that intestinal permeability. When larger strings of amino acids (pieces of food that aren’t entirely broken down) make it through, the body attacks these as foreign invaders (as it should!). This attack can go awry and lead to attack on your own bodily tissues. Intestinal permeability is caused by stress, poor diet, overuse of NSAIDS, alcohol and more..

Genetics: There is a strong association with family history of thyroid disease and developing Hashimoto’s. Several genes have been implicated but, as is true for genetics as a whole, we don’t’ yet have a full understanding of exactly what genes are contributing.

Stress: It feels like we are always talking about stress! The health implications for excessive stress that isn’t managed with healthy outlets are far reaching. Even conventional medicine recognizes the impact stress has on developing Hashimoto’s and hypothesize it is due to the effects of cortisol on the immune system.  When addressing hypothyroidism/Hashimoto’s adrenal health is important to assess.

Radiation exposure: The thyroid is very susceptible to radiation so be sure to ask for a thyroid collar for any X-rays you receive.  Having excessive radiation exposure to your thyroid can increase the risk of thyroid disorders.
 
Typically conventional endocrinologists are not concerned with diagnosing Hashimoto’s. For an endocrinologist, the treatment is the same whether the patient has Hashimoto’s or plain hypothyroidism. In both cases the patient would be given synthetic T4 to replace the under functioning gland.
 
When treating a patient naturopathically the root cause of someone’s condition matters a great deal. With Hashimoto’s the underlying issue is an autoimmune disease that needs to be addressed. With simple hypothyroidism you want to look at co-factors for thyroid hormone production, adrenal health and other issues that could be playing a role. The treatment is very different between Hashimoto’s and simple hypothyroidism. Of note, when someone has an autoimmune disease they are more likely to develop another autoimmune disease so addressing the cause is critical!
 
Diagnosing Hashimoto’s is rather simple and can be done with blood work and/or a thyroid ultrasound. The ultrasound looks for thyroid damage characteristic of Hashimoto’s. Thorough blood work should include:
TSH
FT3
FT4
Anti-TPO antibodies
Anti-TG antibodies
 
Either antibody being elevated beyond normal is a clue that it might be Hashimoto’s. There is a percentage of the population that can have elevated antibodies without an elevation in their TSH or abnormalities of the T3 and T4. Conventionally this is a watch and wait situation. I recommend treating as if the patient has Hashimoto’s and working on diet and any possible underlying causes. In my experience it is possible for a patients antibodies to return to normal levels.

Approach to treatment:
 
Treatment is always tailored to the patient and includes dietary changes with an emphasis on a high antioxidant diet rich in vegetables. We also work to help balance the immune system by using herbs and supplements.  One part of working on this immune reaction is getting to the bottom of what caused it with helping to heal any intestinal permeability and balance the healthy flora in the GI tract.
 
Mind body medicine is important for Hashimoto’s. We must analyze stressors, stress response and any somatic manifestations of that stress. I often ask my thyroid patients, are you able to speak your truth?, with the thyroid located so close the voice box one has to wonder if somatic stress manifestation is one contributing factor to thyroid dysfunction.  
 
I do recommend that patients also use thyroid medication to help treat their Hashimoto’s. Patients who use thyroid hormone can see a reduction in their antibodies. Our goal with naturopathic treatment is to keep the medication dose stable and slow or stop the thyroid destruction. I am often asked if patients can expect to stop their medication eventually and that depends on the extent of the thyroid damage. Typically there will be some lifelong hormone replacement.
 
There is some concern that using natural desiccated thyroid (NDT) such as Armour thyroid, Nature-Throid or WP Thyroid can cause antibody levels to rise. This is mostly a theoretical concern that I have only seen once, maybe twice in practice. Many patients feel better using an NDT over synthetic thyroid hormone. How someone responds to thyroid medication is very individual and unfortunately it is often a trial and error process to find the right match.
 
If you are struggling with Hashimoto’s or simple hypothyroidism I recommend working with a naturopathic doctor to help identify the root cause of your autoimmune disease.
 
 
*The treatment discussion in this article is simplified and meant for educational purposes only. Please consult with a naturopathic doctor before implementing changes to your treatment plan.