Nakazawa - The autoimmune epidemic : bodies gone haywire in a world out of balance-- and the cutting-edge science that promises hope

It takes the human body thousands of years to adapt to new environmental stressesyet in a hundred years weve dumped so many toxic substances into our environment that our immune system is being asked to differentiate between our own body and unrecognizable invaders nonstop. Which makes our body much more likely to make a mistake than it was, say, a century ago. There are just so many more opportunities to make mistakes.

Ahmet Hoke, MD, PhD
Director, Neuromuscular Division, Johns Hopkins Medical Institutions

We have no other good explanation as to why there should be an increase in autoimmune diseases, except for the things to which we are exposed in the environment. Autoimmunity is our immune systems effort to adapt to all the new environmental agents and shifts that were being bombarded with. Its an unsuccessful adaptation, but its our bodys way of trying to fight back.

Noel R. Rose, MD, PhD
Director, Autoimmune Disease Research Center, Johns Hopkins Medical Institutions

A s a faculty neurologist and neuroscientist at the Johns Hopkins Hospital in Baltimore Maryland, I have spent the last decade evaluating and treating patients with autoimmune disorders of the nervous system. I founded and continue to direct the Johns Hopkins Transverse Myelitis (TM) Center, the only center in the world dedicated to developing new therapies for this paralyzing autoimmune disorder. Increasingly, I see that more and more patients are being felled by this devastating disorder. Infants as young as five months old can get TM and some are left permanently paralyzed and dependent upon a ventilator to breathe. But this is supposed to be a rare disorder, reportedly affecting only one in a million people. Prior to the 1950s, there were a grand total of four cases reported in the medical literature. Currently, my colleagues at the Johns Hopkins Hospital and I hear about or treat hundreds of new cases every year. In the multiple sclerosis clinic, where I also see patients, the number of cases likewise continues to climb.

Autoimmune diseases have not always been this common. The prevalence of autoimmune diseases like systemic lupus erythematosus or lupus, multiple sclerosis, and type 1 diabetes is on the rise. In some cases, autoimmune diseases are three times more common now than they were several decades ago. These changes are not due to increased recognition of these disorders or altered diagnostic criteria. Rather, more people are getting autoimmune disorders than ever before.

Something in our environment is creating this crisis. What you will read about in the following pages is a powerful and touching and scholarly expos of what those things may be.

The immune system in our bodies is charged with an amazingly complex task: to recognize and ignore all the cells and tissues within our body andat the same timeto attack any and all invaders, foreign cells, viruses, bacteria, or fungi. Our wondrously complex immune system can successfully protect our bodies while recognizing and eliminating billions of distinct infections with which we come in contact. When functioning well, the immune system immediately recognizes a virus or bacteria that has gotten into our body and initiates a spirited and robust attack on the invader, allowing us to recover from a cold after only a few days. But this precisely choreographed dance between the immune system and the tissues it is designed to protect goes badly awry in autoimmune diseases. In such diseases, the immune system mistakes friend for foe and begins to attack the very tissues it was designed to protect. The soldiers guarding the castle turn and attack it.

But what triggers autoimmunity to occur? Throughout human history, our exposure to such myriad infectious agents has triggered an evolutionary arms race. Our immune system has evolved increasingly sophisticated countermeasures and recognition systems to combat the increasing diversity of the infectious agents with which we come in contact. But this increasing sophistication comes with a cost: an increased chance of the system breaking down. We have evolved right to the edge of the immune systems capacity.

Now, over the last forty years, something has been pushing that system over the edge. Something is causing the immune system to increasingly make mistakes in which the line becomes blurred, the immune system attacks the body itself, and autoimmune disease occurs. In all likelihood, much of the reason for this often catastrophic mistake of the immune system comes from the countless environmental toxins to which we are currently exposedtoxins that interfere with the way the immune system communicates with the rest of the body. To paraphrase W. B. Yeats, when that communication is lost, things fall apart, the centre cannot hold.

The numbers are staggering: one in twelve Americansand one in nine womenwill develop an autoimmune disorder. And since it is clear that not every patient with an autoimmune disease is correctly diagnosed, the prevalence is certainly higher than that. The American Heart Association estimates that by comparison, only one in twenty Americans will have coronary heart disease. Similarly, according to the National Center for Health Statistics, one in fourteen American adults will have cancer at some time in their life. This means that an American is more likely to get an autoimmune disease than either cancer or heart disease. Yet we hear much more in the press about heart disease and cancer than we do about autoimmunity. And this silence is mirrored in relative funding by the National Institutes of Health, the major funding agency for biomedical research in the United States. Though the NIH has expanded funding for autoimmunity significantly over the last several years, the 2003 expenditure of $591.2 million is still only a fraction of the money spent for heart disease and cancer. The NIH budget for cancer is over 5 billion dollars, ten times that of autoimmune diseases. The NIH budget for cardiovascular disease is over 2 billion dollars, four times that of autoimmune diseases. We have not yet recognized the urgency of the autoimmune epidemic.

Why is the prevalence of autoimmunity increasing at such alarming rates? There is almost universal agreement among scientists and physicians that the environmental toxins and chemicals to which we are increasingly exposed are interfering with the immune systems ability to distinguish self from non-self. Most of the risk of autoimmunity comes from environmental exposures rather than from genetic susceptibilities. So, have those environmental exposures changed over time? The answer is clearly yes. One example of this comes from a 2003 study in which blood and urine samples from Americans were tested for 210 substances, including industrial compounds, pollutants, PCBs, insecticides, dioxins, mercury, cadmium, and benzene. The volunteers, none of whom had any occupational or residential risks for such exposure, had detectable levels of 91 of these. In other words, these are ordinary people with ordinary lives who have numerous toxins in their body from ordinary exposure. In a 2005 study, researchers found 287 industrial chemicals, including pesticides, phthalates, dioxins, flame-retardants, and the breakdown chemicals of Teflon, in the fetal cord blood of ten newborn infants from around the countrytransmitted to the infants by their mothers exposures before and during pregnancy.