Dr. Barrett's Blog

Autoimmune Disease Series Episode #5: Chronic Infections

3/3/2021

Authored by Dr. Barrett

This is part five in a series covering autoimmune disease. Don’t miss upcoming articles covering environmental medicine and mind body medicine. Check out previous articles covering Loneliness, GI health, nutrition part 1 and nutrition part 2, and hormones.

Photo by CDC on Unsplash

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. If you scroll to the bottom of this blog there are some citations that go into great detail about how these mechanisms work if you are interested. In an oversimplified nutshell there can be cases of mistaken identity, our immune system getting overexcited, and chronic inflammation.

What is a chronic infection? All of us are likely familiar with an acute infection: you become briefly ill such as from a cold or the flu and then you recover. Acute infections give our immune system practice. I don’t know about you but it’s now been over 12 months since I’ve had an acute infection (thanks physical distancing!) While this is a nice perk of the pandemic it’s not great for our immune systems. A chronic infection happens when the body can’t seem to muster enough of a defense to adequately resolve the infection. Some examples include hepatitis C and HIV. HIV is treatable but at the time I am writing this there is no way to completely resolve the viral infection. Hepatitis C used to be a lifelong infection but with recent advances in drug therapy it’s now possible to be virus free! Some infections can be latent which means you become ill when initially exposed but then the infectious agent remains in the body dormant only to reactivate at a later time. The classic example is the virus that causes chickenpox will remain latent for decades only to emerge during a time of stress as shingles. Another example of a latent virus is the herpes simplex virus which can cause cold sores or ‘fever blisters’. The herpes family of viruses actually ‘sense’ when stress hormone levels rise and activate to come out of latency. Then the virus triggers a hormone cascade to actually further raise the levels of stress hormones. It’s genius and of course not great for us. There are many pathogens that can be latent or chronic.

When treating autoimmune disease we are always looking for the root cause(s). We can use symptoms as clues that there may be a chronic infection to deal with. Some of those symptoms include; low grade fevers, migratory joint pain, recurrent hives, muscle pain, crawling sensation, as well as exacerbation and remission of symptoms. We can also use the knowledge of which pathogens are commonly associated with particular autoimmune diseases. For example, the bacteria klebsiella is implicated in the development of ankylosing spondylitis (AS), an autoimmune joint disease impacting the spine. Antibodies against klebsiella are found in AS patients. AS patients tend to have elevated levels of klebsiella in their stool and reduction of this bacteria can reduce the severity of AS. A combination of signs, symptoms and empirical knowledge will lead us to suspect chronic infections.

Unfortunately, testing for chronic infections is challenging. Sometimes standard lab work can provide clues. We can see chronically low or high white blood cells and/or a chronically low/low normal RDW on a CBC. When testing for specific infections we must look for antibodies specific to that infection. This requires running several tests for each infection you are looking for. Let’s use Epstein-Bar (EBV) as an example. When looking for this infection we will often run: EBV viral capsid IgM, EBV viral capsid IgG, EBV nuclear antigen, and EBV early antigen IgG. If we want to test for other viral infections we will need a similar list of labs. You can see the list of labs gets very long and it can become incredibly expensive.

Once I suspect a chronic infection the first steps I take are to support the person as a whole. All of us are exposed to infectious agents that can cause chronic infections. Instead of jumping to herbs/medications that can eradicate the infection I first want to identify what about this patient is allowing this infection to persist. In Naturopathic medicine we use the language ‘terrain’ to describe the environment in the host (patient). We need to make the terrain more inhospitable, strengthen the patient, and then go after the infection.

The following are some avenues we explore together in strengthening the patient and creating an inhospitable terrain:

Getting blood sugar in check
Optimize nutrition
Making sure stressors and more importantly the stress response is under control
Prioritizing rest
Ensuring adequate sleep
Optimize GI health and the microbiome

I will leave you with an example from Hashimoto’s disease, a condition I treat frequently. People with Hashimoto’s Thyroiditis (HT) have higher levels of EBV viral capsid IgG and early antigen IgG. In one study researchers looked at surgical specimens of thyroid tissue and found that 34.5% of the tissue from HT patients contained signs of EBV etiology. Does this mean that I test every Hashimoto’s patient for EBV during the first visit? No. We start with the list above while monitoring thyroid function and antibodies. Remember it’s not about the bug, we must work on the ‘terrain’ first and then go after chronic infections.

References:
Infectious diseases and autoimmunity
Molecular Mimicry, Bystander Activation, or Viral Persistence: Infections and Autoimmune Disease
Virus infection, antiviral immunity, and autoimmunity
Role of Chronic Bacterial and Viral Infections in Neurodegenerative, Neurobehavioral, Psychiatric, Autoimmune and Fatiguing Illnesses: Part 1 and Part 2
Social stress and the reactivation of latent herpes simplex virus type 1
The relationship between Klebsiella infection and ankylosing spondylitis
Study of Epstein–Barr virus serological profile in Egyptian patients with Hashimoto’s thyroiditis: A case-control study
The role of Epstein-Barr virus infection in the development of autoimmune thyroid diseases

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AUTOIMMUNE DISEASE SERIES EPISODE #4: HORMONES

12/14/2020

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This part three in a series covering autoimmune disease. Don’t miss upcoming articles covering chronic infections, environmental medicine and mind body medicine. Check out previous articles covering GI health, nutrition part 1 and nutrition part 2.

Photo by Simone van der Koelen on Unsplash

Hormone balance can often be an overlooked part of autoimmunity. I see a lot of emphasis on GI health (rightfully so) but autoimmune diseases are complex so it makes sense that the etiology is also complex.

A hormone is a signaling molecule released into circulation to target distant organs and regular physiology or behavior. In layman’s terms hormones are tiny middle managers running around the body bossing organs and tissues around. Hormones are involved in most of the activities of our bodies including digestion, sleep, stress, growth, reproduction and mood - just to name a few. We have somewhere upwards of 50 different hormones in the body with varying degrees of relationship to autoimmune disease. I am going to pick a few to highlight for you.

Estrogen
Autoimmune disease in general tends to target people with ovaries.* A current hypothesis is that estrogen might actually enhance the inflammatory process of the immune system (1). Interestingly, even the joint fluid in RA patients contains higher levels of estrogen regardless of sex (2). I will cover this more extensively in the upcoming article on autoimmune disease and environmental medicine but I want to note that we are exposed to many chemicals that are ‘estrogen-like’ (xenoestrogens) such as BPA. So it’s important to test your individual hormones as well as look at what endocrine disrupting chemicals you are exposed to in your environment.

Prolactin
Prolactin’s major role in the body is to stimulate lactation and suppress reproduction. Prolactin also stimulates the immune system as well as enhances the production of immunoglobulins and autoantibodies (3). Elevated levels of prolactin have been noted in Lupus (SLE), Rheumatoid arthritis (RA), Sjogren’s, Hashimoto’s and Multiple Sclerosis (MS) (4). Prolactin levels tend to be higher in folks with ovaries. Prolactin also elevates during chronic stress (5). Prolactin is an inexpensive blood test.

Testosterone
Testosterone levels are naturally higher in folks with testes, which might have a protective effect against autoimmune disease. The effects of estrogens on immunity have been extensively studied but less is known currently about how androgens such as testosterone impact the immune system. We do know that mice with autoimmune disease have an increase in disease activity when they are castrated (ouch!) and androgen treatment improves survival in mice with Lupus (6).

It’s important to look at the pathways. If you have a patient with low testosterone and elevated estrogen they might be converting their testosterone into estrogen via aromatase. So reducing aromatase activity is a better treatment plan than just replacing testosterone.

Cortisol
I will cover cortisol extensively in an upcoming article on mind-body medicine and autoimmune disease. In a nutshell, cortisol is supposed to be released in short bursts when we are under acute stress (running from a bear for example). Our bodies were not designed to be bathed in cortisol which is all too common these days. We have pesky chronic infections lurking behind the scenes just waiting for our immune system to be suppressed. Epstein-Barr Virus (EBV), varicella and herpes all contain stretches of DNA that sense cortisol levels and when these levels are elevated, the viruses reactivate (7). These viruses are implicated in autoimmune disease, especially EBV (8).

I like to use a combination of blood, saliva and dried urine (DUTCH) hormone testing to get an overall picture of hormone balance. Hormone pathways are complicated as you can see by this chart below. Just looking at a blood estrogen level isn’t enough. You can have a ‘normal’ estrogen level but if you are converting most of your estrogen into 16-OH that can make autoimmune disease worse. Testing is key.

If you are struggling with an autoimmune disease I recommend working with a naturopathic doctor to help identify the root cause and support your body.

*In general I do my best to use gender neutral language in my articles and presentations. We are all unique and using ‘women’ and ‘men’ just isn’t descriptive enough. Trans-men may still have ovaries, cis-women can have their ovaries removed for all sorts of reasons, etc. So I use the language ‘folks with ovaries’ and ‘folks with testes’ to be clear about the people I am talking about and the hormonal implications.

References:

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AUTOIMMUNITY SERIES EPISODE #3, PART 2: NUTRITION

11/16/2020

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This part two of the nutrition article in a series covering autoimmune disease. Don’t miss upcoming articles covering chronic infections, hormones, environmental medicine and mind body medicine. If you missed the first articles covering GI health or loneliness check those out! I have so much to say about nutrition I had to break it into two articles! Check out the first article here.

Photo by Nadine Primeau on Unsplash

In part one of this article I reviewed several nutrients that benefit the immune system and the foods rich in those nutrients. In addition to looking at specific nutrients and how they impact our immune system we can also look at particular inflammatory mediators and discuss what foods or nutrients can be beneficial. One example is NF-κB, a well-known pro-inflammatory mediator. When NF-κB is deregulated, it’s associated with the chronic inflammation of autoimmune diseases. NF-κB has been implicated in a number of autoimmune diseases, such as rheumatoid arthritis, systemic lupus erythematosus, type I diabetes, multiple sclerosis and inflammatory bowel disease (1). Certain foods and nutrients modulate NF-κB, these include:

Green tea
Curcumin
Rosemary
Grapeseed extract
Selenium (brazil nuts)
Indole-3-Carbinol (cruciferous veggies)
GLA (hemp and borage oil)
Zinc (pumpkin seeds, oysters, beef)

Foods that modulate NF-κB are just one example of how food can be our medicine. We could pick other important inflammatory mediators such as TNF-alpha or IL-6 and review which foods support a healthy response for these markers specifically. Instead of doing that I am hoping to convey that a whole foods diet rich in variety is supportive of a healthy immune system.

Let’s pivot to some components of our diet that can impair our immune system.

Moderation is important. But it’s also important to be realistic about what is truly food for humans and what is not. With the rise in packaged and convenience foods, we have been brainwashed to think that diet soda, boxed macaroni and cheese with a laundry list of unknown ingredients, and twinkies that never expire are food. Here's a baseline for determining food from not-food: if it wasn’t around for your great-grandmother to eat, it’s not food.

Food additives are particularly concerning and the amount of additives in our food has skyrocketed. A review article published in the journal Autoimmunity Reviews in 2015 found that changes in intestinal tight junction permeability (i.e. 'leaky gut') are associated with industrial food additives and may explain the rising incidence of autoimmune disease. (2) We must be vigilant in reading food labels and striving to minimize our consumption of processed foods.

There are two more things we must cover when discussing nutrition and autoimmune disease: sugar and alcohol. Both of these were around for your great-grandmother to consume, but we are indulging in much higher quantities and to our detriment. Sugar and alcohol are good examples of where we need more moderation. Many people end up eating much more sugar than they realize because it’s hidden in so many of our packaged foods and beverages. Start bringing more awareness to your sugar intake by reading ingredients and nutrition labels on packaged food that you purchase. Sugar is inflammatory, can contribute to ‘leaky gut,’ and is damaging to our immune system.

Note: When I use the word ‘sugar’ I am talking about refined products such as sugar cane, beet sugar, corn syrup, dextrose, maltodextrin, rice syrup etc. I am not talking about fruit. I see fruit lumped into the ‘sugar’ category and demonized right along with it so I want to be clear - fruit is an important part of a balanced diet.

Regular and excessive use of alcohol is normalized in our culture. Unfortunately, alcohol is very irritating to the GI lining, depletes the body of nutrients, and impairs our immune system. This is a link to a chapter in a medical text that walks through how alcohol impairs the immune system. Be forewarned, there are MANY complicated mechanisms. Safe alcohol consumption is no more than 1 drink per day for women and 2 drinks per day for men. A binge is drinking 4 or more beverages in 2 hours and 1 in 6 US adults binge drink 4 times or more per month (3). Excessive alcohol use is a problem in our country and, unfortunately, the stress of a pandemic is exacerbating this problem. If you find yourself drinking more than usual, consider other activities to help manage your stress such as an Epsom salt bath, exercise, time with friends, etc. If you need help to reduce your drinking, please consider talking to your doctor or mental health professional.

Many of the ‘diets’ found on the internet claiming to treat autoimmune disease focus heavily on what you should avoid. I hope this article has helped you see that instead of looking at tomatoes or other whole foods as a major culprit we should be looking to food additives, sugar and alcohol. There are so many critical nutrients for our immune health and eating a wide variety of foods is our best chance for adequate consumption.

In part one we reviewed critical nutrients to support the immune system and in part 2 we reviewed non-food compounds that can damage the immune system such as additives, sugar and alcohol. But we haven’t talked about the middle ground: foods that are inflammatory for some folks and not others. This is where individualized medicine comes in. Some people react poorly to dairy and it could be part of the problem. Other folks consume dairy without issue. I’ve even experienced a case where garlic was the migraine trigger. We are all unique and what foods nourish our bodies is different person to person. So before you jump on a ‘one size fits all’ diet plan for autoimmune disease, consider consulting with a professional who can help guide you.

Resources:

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AUTOIMMUNITY SERIES EPISODE #3, PART 1: NUTRITION

10/14/2020

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This is the third article in a series exploring autoimmune disease with a holistic lens. Don’t miss upcoming articles diving into chronic infections, gut health, nutrition part 2, hormones, environmental medicine and loneliness.

Photo by Karsten Winegeart on Unsplash

There are no shortage of ‘diets’ out there claiming to treat or improve autoimmune disease. You may have come across AIP (Autoimmune Paleo), low-nightshade, gluten-free, sugar-free, vegan, and the carnivore diet, just to name a few. In this two-part blog, I aim to provide research around nutrition and the immune system and put to rest the notion that you must follow a strict ‘diet’ if you have an autoimmune disease. Instead, we need to consume a variety of whole foods, especially plants, and limit non-food additives/preservatives that are commonly found in packaged foods.

I am going to start by highlighting the importance of a few key nutrients that you may be low in if you are currently eating the SAD, or Standard American Diet. According to the most recent US Dietary Guidelines, there are 7 nutrients that most American’s aren’t getting enough of: calcium, potassium, fiber, magnesium, vitamin A, vitamin C and Vitamin E.(1) Several of these are critical for our immune system. Below, I outline a few reasons why each is important for immune function and include some food options to get more of each.

Vitamin A: Vitamin A is critical for immune tolerance. Researchers from Emory University found that “Dendritic cells, the microbe-sensing alarms of the immune system, can send out a "red alert" to stimulate immunity, or a "calm down" message that tones down excessive immunity that might damage the host. The "calm down" message makes use of vitamin A, providing an explanation for the link between vitamin A deficiency and autoimmune diseases.” (2)
Food sources: (3) liver, meat, dairy and fish contain preformed vitamin A. Sweet potato, pumpkin, spinach, carrots, cantaloupe and sweet peppers contain a precursor to vitamin A

Vitamin C: This might be the most ‘famous’ immune supportive nutrient. Vitamin C is a potent antioxidant and required for many reactions in our body. Vitamin C supports both the innate and adaptive immune system (4). When we don’t have adequate vitamin C in our tissues we can develop impaired immunity and higher levels of inflammation.
Food sources: (5) raw sweet peppers, oranges, grapefruit, kiwi, broccoli, strawberries, and Brussels sprouts

Vitamin E: Vitamin E is well known for its antioxidant activity but lesser known for its role in the immune system. Vitamin E is highly concentrated inside of white blood cells and plays a role in stimulating our defense mechanisms. A literature review published in Reviews in Clinical Medicine found “A decrease in the serum levels of vitamin E in almost all autoimmune diseases. Furthermore, there is evidence regarding the possible therapeutic value of vitamin E in the management of autoimmune diseases.” (6) A clinical trial from 1978 found that providing vitamin E to patients with varying autoimmune skin conditions provided benefit.(7)
Food sources: (8) wheat germ, sunflower seeds, almonds, sunflower oil, safflower oil, hazelnuts, peanut butter

Fiber: I don’t have any interesting research studies to share on fiber and the immune system. I bring up this important nutrient because fiber is a major way that we feed our beneficial flora otherwise known as the microbiome. I explained the importance of our microbiome in my article Holistic Autoimmunity Series: Gut Health (link to GI and autoimmune article) so I will be brief. Our microbiome helps to train our immune system and likely play an integral role in autoimmune disease. So eat fiber to feed your microbiome friends!
Food sources: (9) beans, chia seeds, flaxseeds, barley, green peas, raspberries, pear

Omega-3’s: A nutrient that I believe is missing from this list is omega-3 fatty acids. The most important fatty acids for immune health are EPA and DHA which are found in certain fish. Omega-3’s reduces tumor necrosis factor-α and interleukin-6 production which are two inflammatory signals in the body (10). Omega-3’s are also important because autoimmune disease increases the risk of cardiovascular disease via increased inflammation and omega-3’s can help reduce that risk. “Many of the placebo-controlled trials of fish oil in chronic inflammatory diseases reveal significant benefit, including decreased disease activity and a lowered use of anti-inflammatory drugs.” (11).
Food sources: There is an acronym that helps me remember these fish; SMASH (Salmon, Mackerel, Anchovies, Sardines, and Herring). It’s ideal to consume a fish high in omega-3’s twice per week. Food is best, but if you can’t get these in twice per week I recommend using a fish oil supplement.

Vitamin D: I would be remiss if I didn’t at least touch on vitamin D. We don’t get much from food BUT it’s name is vitamin D so I will include a brief note about it here. Vitamin D truly acts as more of a hormone in the body. We make vitamin D from cholesterol when our skin is exposed to sunlight. It’s challenging to make enough in Minnesota since we are so far from the equator where the sun’s rays are the most direct. A literature review conducted in 2016 found “an inverse association between vitamin D and the development of several autoimmune diseases, such as SLE, thyrotoxicosis, type 1 DM, MS, iridocyclitis, Crohn's disease, ulcerative colitis, psoriasis vulgaris, seropositive RA, polymyalgia rheumatica.” (12). What this means is that when your vitamin D levels are in an optimal range you are less likely to develop an autoimmune disease. I advocate for testing vitamin D levels in patients and typically aiming for a blood level around 60 ng/mL.
Food sources: We can get some vitamin D from mushrooms, pasture-raised egg yolks and liver, but this is usually not enough to meet biological needs.

Resources:

Additional reference not specifically cited above: Diet, Gut Microbiota, and Vitamins D + A in Multiple Sclerosis

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AUTOIMMUNITY SERIES EPISODE #2: GUT HEALTH

9/2/2020

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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.

The National Institutes of Health estimate that 5-8% of Americans have an autoimmune disorder. There are approximately 80 human diseases caused by an autoimmune response and that list keeps getting longer. Autoimmune disease occurs when our immune system attacks our own tissues by mistake. This attack can escalate and lead to tissue destruction such as the joint tissue destruction seen in Rheumatoid Arthritis (RA).

Naturopathic Medicine takes a holistic or whole-person approach to treating and managing autoimmune disease. An important part of the holistic approach is to explore root causes or triggers of disease. We go searching for areas where the body is out of balance. In a series of articles I will cover different aspects of this search for root causes for autoimmune disease including environmental exposures, hormones, mind/body medicine, nutrition, and chronic infections. We are starting with a major area - gastrointestinal health.

Gastrointestinal (GI) or ‘gut’ health is a foundation of Naturopathic treatments. You have probably heard the saying ‘health starts in the gut’. There is a lot of truth in that statement for several reasons; the GI tract is responsible for digestion and assimilation of nutrition, it’s where the majority of our immune system and microbiome reside, and it’s a major training ground for our immune system.

Microbiome: We have trillions of microorganisms (bacteria, viri, parasites) living in our GI tract. This is called the microbiome or gut microbiota. Your microbiome starts to develop the moment you are born and complete colonization occurs within the first three years of life. Starting at birth, our microbiome helps train the developing immune system. The commensal (good) microbes can directly attack the disease causing microbes signaling to the human immune system when to launch an attack. This training also includes teaching the immune system to ignore harmless stimuli (such as pollen or even self tissue). Without this critical training we are more at risk for conditions such as autoimmune disease and allergies.

When our microbiome is unstable or out of balance it is called ‘dysbiotic’. We are finding that a dysbiotic flora or dysbiosis is a factor in many conditions including autoimmune disease. Dysbiosis increases the production of inflammatory cytokines.

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. Klebsiella in the GI has been associated with ankylosing spondylitis and ulcerative colitis; Yersinia in the GI has been associated with autoimmune thyroid conditions; Citrobater in the GI has been associated with rheumatoid arthritis to name a few. Association isn’t causation but it warrants investigation especially into the microbiome of patients with autoimmune disease.

Intestinal permeability: 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 into your bloodstream. When there is a breakdown in this process and larger particles are allowed into 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, food additives, overuse of NSAIDS, alcohol and more.

Assessing digestive health is often a first step working with autoimmune patients. Each approach is tailored to the patient.

If you are struggling with an autoimmune disease I recommend working with a naturopathic doctor to help identify the root cause and support your body.

Resources:

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AUTOIMMUNITY SERIES EPISODE #1: LONELINESS

7/20/2020

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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 part 1 + part 2, hormones, environmental medicine and mind body medicine.

Photo by Keenan Constance on Unsplash

I am fascinated by the connection between loneliness, social isolation, community and our health. I am not alone, there is an entire field called sociogenomics that is dedicated to examining how social factors affect the activity of our genome. Most of us know that we should ‘eat right,’ sleep well and exercise. The jury is still out on how to eat right, how much to sleep and exactly what kind of exercise is best BUT we at least have awareness around how these areas impact our health. Unfortunately loneliness is on a dramatic rise and the effects on our health are pervasive.

You can feel terribly alone in a crowd and perfectly content being alone. Loneliness is a subjective emotional state; it is the perception of loneliness that matters. Humans have an instinctive need to belong, this need is as basic to human functioning and survival as the need to obtain food, water and shelter. When this need is not satisfied it impacts not just our psychological health but also our physical health.

The health risks associated with loneliness are comparable with well-established risk factors for disease such as physical inactivity and substance abuse. Loneliness increases mortality to the point that it is similar to smoking 15 cigarettes per day! If that isn’t startling enough, the World Health Organization predicts that loneliness will reach epidemic proportions by 2030.

In 2018, CIGNA surveyed 20,000 US adults using UCLA’s loneliness scale and here is what they found:

1 in 2 reported sometimes or always feeling alone
1 in 4 rarely or never feel as though there are people who really understand them
2 in 5 sometimes or always feel that their relationships are not meaningful
1 in 5 rarely or never feel close to people
Generation Z (18-22) is the loneliest generation

What does this have to do with autoimmune disease? Loneliness actually changes how our immune system is working. Our cellular immunity is impaired, natural killer cells decline, and antibody titers rise. Loneliness triggers our fight/flight/freeze stress response. Humans have spent most of our existence as a species being supported and protected by each other. Loneliness signals to our body that we are in danger, which kicks up our levels of inflammation and changes our immune response.

Inflammation impacts regions of the brain that process fear and anxiety, thereby changing people’s experience of the world. Loneliness may act as a regulatory loop. Lonely individuals have increased sensitivity and surveillance to social threats. They preferentially attend to negative social information while remembering more of the negative aspects of social events. This leads lonely individuals to behave in ways that confirm their negative expectations. These changes in behavior perpetuate loneliness.

The real kicker for me is that folks who have or develop a chronic illness, such as an autoimmune disease, have a higher risk for becoming socially isolated. So not only does loneliness increase the risk of developing an autoimmune disease, having an autoimmune disease increases your risk of becoming lonely. Let’s attend to our social health.

No one has the answers to this problem but what is clear is that loneliness is skyrocketing in developed nations. Moving out and living on your own is a right of passage. We walk around with airpods in our ears and our faces in our phones. These days it is very easy to feel alone in a crowd.

I propose a simple shift in mindset. Instead of the mentality that meeting a friend for coffee is a ‘treat’ let’s put it on par with your morning exercise or your kale salad. I also just want to remind all of us (myself included) in this era of ‘instagram selves’ to not forget who we truly are, and show up with authenticity to our friendships. Nurture your relationships, spend time with the people you care about. Your health depends on it.

References:

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Autoimmune Disease Series Episode #5: Chronic Infections

AUTOIMMUNE DISEASE SERIES EPISODE #4: HORMONES

AUTOIMMUNITY SERIES EPISODE #3, PART 2: NUTRITION

AUTOIMMUNITY SERIES EPISODE #3, PART 1: NUTRITION

AUTOIMMUNITY SERIES EPISODE #2: GUT HEALTH

AUTOIMMUNITY SERIES EPISODE #1: LONELINESS

Dr. Barrett

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