Women’s Health: A Whole-Person Approach to Autoimmunity

Women are disproportionately affected by autoimmune conditions. What’s behind their increasing prevalence, and what does effective treatment look like?
Women are disproportionately affected by autoimmune conditions
Women are disproportionately affected by autoimmune conditions

Illustration by Good Studio/Adobe

Lindsey Cacich Samples started feeling unwell after she had her daughter in 2017. Stress, lack of sleep, and juggling work and motherhood took a toll on the Minneapolis-based theater artist and educator. “It got to the point where I was consuming so much coffee and sugar just to be awake and operate,” she recalls. “I had so much brain fog and fatigue, and I felt like my whole aura was gray.”

She started working with a nutritionist and learning about functional medicine, which emphasizes diet and lifestyle as tools for healing. It helped a bit, but then came the extreme stressors of 2020. In the unrest following George Floyd’s murder, Samples and her family had to go stay with her parents for several days while their neighborhood was on fire. “Between that and the pandemic, my nervous system was so jacked up,” Samples says.

That August, she started losing feeling in her fingers, toes, and eventually the entire right side of her body. She went to the emergency room, and an MRI showed lesions on her brain. The doctors diagnosed her with multiple sclerosis, an autoimmune condition of the brain and spinal cord.

After being diagnosed with multiple sclerosis in 2020, Lindsey Cacich Samples says she changed her diet and started to feel better
After being diagnosed with multiple sclerosis in 2020, Lindsey Cacich Samples says she changed her diet and started to feel better

Photo by Caroline Yang

The rise in autoimmune conditions

Rates of autoimmunity—conditions in which the immune system attacks the body’s own cells and tissues—have been on the rise for decades, according to the National Institutes of Health. Autoimmunity is a big umbrella, encompassing more than 100 known conditions. These include type 1 diabetes, rheumatoid arthritis, lupus, Hashimoto’s thyroiditis, and inflammatory bowel disease. According to the American Autoimmune Related Diseases Association, roughly 50 million Americans have one or more autoimmune diseases. Seventy-five percent of those suffering from an autoimmune condition are women.

The rise in autoimmunity—and the gender disparity in those affected—extends to children as well. “The prevalence of pediatric autoimmune diseases has doubled in the past 10 years,” says Dr. Allison Golnik, a pediatrician with M Health Fairview who practices both functional medicine and traditional pediatrics. And according to the Boston Children’s Hospital, girls are almost three times as likely as boys to have an autoimmune disease, with adolescent girls and young women at greatest risk.

There are several theories for why women and girls are overrepresented in autoimmune conditions, ranging from the role of sex hormones, to women’s X chromosomes, to sex-based differences in the gut microbiome. A couple of these theories may also account for autoimmunity’s increasing prevalence.

Estrogen-mimicking chemicals, including bisphenol A (BPA), which is found in plastic, canned foods, and personal-care products, can disrupt the modulation of inflammatory proteins called cytokines, which help to regulate immune cells. Also called hormone-disruptors or endocrine-disruptors, these chemicals have become ubiquitous in plastic products and food packaging.

“The fact that there’s such a gender disparity in rates of autoimmunity really makes me think that endocrine disruption is a very important issue,” says Dr. Gregory Plotnikoff, founder and medical director of MN Personalized Medicine.

Diet is another likely contributing factor, Golnik says. “Two-thirds of kids’ diets are made up of ultra-processed foods with additives like preservatives, dyes, flavorings, and emulsifiers. When we put these foreign substances into our body, the body often has an immune response. When there’s more and more inflammation over time, the immune system can start reacting against the self, starting the autoimmune process.”

The standard Western diet is also notoriously low in fiber, which is needed to nourish a robust microbiome (the ecosystem of bacteria and fungi in the gut). An imbalanced or diminished microbiome can lead to “leaky gut,” which happens when the tight junctions in the gut lining loosen, allowing the contents of the digestive tract to leak into the body and spark an immune response.

Glyphosate, a chemical in the world’s most commonly used herbicide, has been linked to changes in the microbiome that can lead to leaky gut. One study found that glyphosate levels in the human bloodstream have spiked by more than 1,000% in the last two decades.

Adults and children alike are also reporting higher levels of stress, less quality sleep, and less movement—all risk factors for immune dysregulation.

Treating autoimmunity: Addressing the fundamentals

The standard approach to treating many autoimmune conditions involves medications to suppress the immune system. This can help mitigate symptoms but also leave patients vulnerable to side effects, including increased susceptibility to infection, high blood pressure, cataracts, sleep disturbances, and osteoporosis.

Samples received her MS diagnosis during a three-day stay in the hospital over Labor Day weekend in 2020. Her doctors recommended she immediately start an aggressive course of steroids to suppress her overactive immune system. But Samples had seen a friend with MS struggle with the medication route, and she wanted to do everything she could to avoid it herself.

“I had a lot of fingers wagged in my face and doctors trying to invoke fear to get me to comply. Luckily, I had all of this knowledge ready about functional medicine, so I knew being aggressive with medication wasn’t the only option,” Samples says.

Instead, she started following the Wahls protocol—a specialized diet designed by Dr. Terry Wahls, an Iowa physician and researcher who used it to reverse her own MS. The Wahls protocol is similar to a paleo diet, eliminating gluten and dairy and emphasizing vegetables, organ meats, and fermented foods. “It was amazing how fast things started changing for me,” Samples says. “The brain fog disappeared. My fatigue started waning. I just did a complete 180.”

“Functional medicine recognizes that food is medicine, and foods have direct effects on cells,” Golnik explains. Removing inputs that are contributing to inflammation, while supporting the cells, processes, enzymes, and gut bacteria that balance the immune response can have a profound effect not only on suppressing symptoms but on halting the underlying disease process.

This is not to say that there’s no role for medications in treating autoimmune conditions. For Plotnikoff, it’s a question of emphasis. “My bias is to focus on fundamentals first, then pharmaceuticals. Too often, in my opinion, the system jumps at pharmaceuticals and forgets the fundamentals,” he says.

The five fundamentals of health, according to Plotnikoff, are breathing, eating, sleeping, moving, and a life of connectedness and meaning. “If I solely prescribe medications to suppress symptoms, I disempower people, and my goal is to support people’s independence from the medical system as much as possible,” Plotnikoff says.

Lindsey Cacich Samples
Lindsey Cacich Samples

Photo by Caroline Yang

New tools and advances

Bioelectronic stimulation is also an emerging tool that’s showing promise in treating a range of inflammatory conditions, including autoimmunity. The vagus nerve runs from the brain to the large intestine and regulates functions such as digestion, heart rate, and respiratory rate. Targeting the vagus nerve with electrical pulses has been shown to reduce inflammation and provide relief from symptoms of rheumatoid arthritis, inflammatory bowel disease, and other chronic autoimmune conditions without harmful side effects.

Plotnikoff uses a handheld vagus nerve stimulation device called GammaCore with many of his patients, including some with rheumatoid arthritis. About the size of a cellphone, GammaCore is held against the vagus nerve in the neck, where it delivers electrical stimulation in two-minute increments. Several of Plotnikoff’s patients have seen dramatic results. “This really is a game changer for a lot of people. It appears to play a very important role in improving quality of life,” he says.

Unlike medication, Plotnikoff sees GammaCore as a bridge to lifestyle measures that reduce stress and balance the nervous system long term. “It gives people rapid, firsthand experience that, yes, you can feel comfortable, you can feel relaxed, you can have better sleep. And that requires attentiveness to things that are counterbalancing,” he says.

Ultimately, each person’s journey with autoimmunity is as unique as they are. The most successful outcomes require a combination of personalized medical treatment and the patient’s active participation in the healing journey. “I advocate for people to dive in and go on the journey. It’s not a passive process,” Golnik says.

Samples agrees. The changes she’s made to her diet and lifestyle have helped her thrive like never before, without any of the symptoms that plagued her before her diagnosis with MS. “I’ve never felt better in my entire life,” she says. “And the reason I’m thriving is because of my own work.”

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