Under friendly fire

What do Amitabh Bachchan, Halle Berry, Venus Williams and Kim Kardashian have in common? All are victims of their own immune systems and suffer from autoimmune disease (AID). Berry has type 1 diabetes, Williams has Sjorgen's Syndrome, Kardashian psoriasis and Bachchan must constantly fight the effects of myasthenia gravis.

But why should we be concerned? Because, depending on your genes and the influence of the environment around you, almost everyone is susceptible to AID.

Luckily, the condition only affects between 5 and 7 per cent of the population in developed countries — although it is one of the leading causes of death for women under 65, according to the United Nations NGO Health Committee and the American Autoimmune Related Diseases Association.

AID arises when the body's immune system overreacts to substances and tissues normally present in the body, mistaking a natural part of the body as a pathogen and attacking its own cells. AID can affect one or many tissues and organs. There are more than 100 different AIDs, which include juvenile and type 1 diabetes, cancer, lupus, multiple sclerosis, psoriasis, Graves' disease, rheumatoid arthritis, Crohn's disease and vitiligo among others.

The UAE is only beginning to fathom how rife the condition is within its population (local and expatriate). While there is little extensive research about AID in the UAE, recent updates in the Catalogue of Transmission Genetics in Arabs database provide some valuable insight: 6 per cent of genetic disorders in Arabs are attributed to disorders of the blood and the immune system. In a recent press statement Dr Mahmoud Taleb Al Ali, Director of Centre for Arab Genomic Studies, said: "61 per cent of genetic disorders in Arabs are inherited; genetic disorders with well established records in the database are sickle cell anaemia, beta-thalassemia, diabetes mellitus non-insulin dependent, glucose-6-phosphate dehydrogenase deficiency, and Down syndrome." All these conditions are linked to AID.

Globally, AID remains uncommon in developing countries, but is increasing in developed nations. Studies found that lupus is four times more likely to strike people of African descent who live in London than those who live in sub-Saharan Africa. In India, where AID is rare among the poor, rates are now rising among the middle class. Although the exact cause isn't known yet, research has revealed that genes play a key role in AID by making some people more susceptible. However, while genes may load the gun, the environment is what seems to be pulling the trigger, explaining 70 per cent of the risk.

The barrel effect

Imagine your body is a barrel that acts as a receptacle for everything you put into it. The trouble starts when the barrel begins to overflow and our immune system, unable to cope with the ‘toxic stew', begins a blanket attack on both our healthy and unhealthy cells and organs. This is a bite-sized version of Donna Jackson Nakazawa's visual metaphor, ‘the barrel' effect, detailed in her groundbreaking book, The Autoimmune Epidemic.

"Barrels differ for each person due to his or her unique genetic composition," says Nakazawa. "As long as our barrel is less than full, our immune system can still deal with what it confronts every day. But once it becomes overburdened, it begins to send mixed signals, causing it to attack the body. Our modern way of life has created a perfect storm of factors — a host of chemicals, heavy metals, processed food additives, viral hits and stressors — for today's autoimmune epidemic to take hold." Much of what we encounter today, she says, causes our barrel to fill to the brim and spill over — at which point disease strikes.

"If a person suspects he/she has AID, the first step is to approach > the doctor related to the symptoms they first notice," says Dr Humeira Badsha, Rheumatologist, Al Biraa Arthritis and Bone Clinic, Dubai. "For instance, swollen joints or acute stiffness first thing in the morning (that persists for over half an hour) is a red flag and should be shown to a rheumatologist. Sudden skin rashes or patches with unknown history should be shown to a dermatologist. Similarly people with non-specific symptoms such as chronic fatigue or tiredness need to approach a GP. Once you've addressed the symptoms, you can proceed further to test for AID."

In the UAE, health experts have noticed a prevalence of certain AIDs — Hashimoto's thyroiditis, type 1 diabetes, rheumatoid arthritis, lupus, and multiple sclerosis — among others. Dr Neil Rangel, Endocrinologist, Welcare Hospital, says close to 20 per cent of the global population possess a ‘dominant genetic disposition or trait' towards AID, although just a minority manifests the disease as the trait does not always get triggered. However, when it does it can manifest in several ways in a family or as different AIDs. Multiple genes are involved, which can collectively increase one's vulnerability or susceptibility.

"There are no autoimmune doctors, just specialists who treat different parts of the body," says Nakazawa, whose own battle with Guillain-Barré Syndrome drove her to research and write her book. "Autoimmune symptoms mimic other illnesses or take their time to manifest completely; there is almost always a delay in diagnosis. Once you've tested your symptoms with your doctor and still need to go further, then approach a research or university hospital specialist who has dealt with AIDs before. Constantly monitoring symptoms and understanding which school of possible disorders it falls into can help lessen the delay of diagnosis."

Triggers around us

Our immune systems are wired to deal with the toxins or pathogens we're exposed to on a daily basis. However, the unprecedented industrialisation of the last hundred years has outpaced our immune system's ability to keep up. Experts say that it takes the human body thousands of years to adapt to new environmental stresses, but the last hundred years has rendered our immune system unable to differentiate between our own body and its unrecognisable invaders.

"We live in what I call an increasingly chemical and toxic planet," says Dr Rangel. "Everything is polluted: the air we breathe, what we eat and drink, what we wear and what we use. Then there is the role of increasingly stressful living. These undoubtedly act as direct or indirect triggers, influencing the immune and endocrine systems. No one seems to want to give up ‘toxic and chemical luxuries' for a healthier living."

Recent research show that chemicals such as bisphenol-A in the lining of food cans that are consumed by the billions have been shown to be an endocrine disruptor, which mimics the female hormone estradiol. Urethane used to make polyurethane (thermacol) cups and plates and confetti has been confirmed as a toxin.

Research in autoimmune disease has also inspired the hygiene hypothesis, which states that the root cause of rising rates of immune-related diseases stems from living in too clean a world. Our lack of exposure to certain viruses and the swill of bacteria that our ancestors were exposed to without vaccines or modern hygiene means our children's immune systems are no longer forced to build up the necessary immune defences they need. In a world of well-vacuumed homes, scrubbed bathrooms and more time spent indoors and cars rather than outdoors, coupled with massive vaccination programmes that prevent full-fledged infection from many childhood diseases, overprotect our immune systems.

"Overall people need to maintain a healthy lifestyle and be more aware of their choices," says Dr Badsha. "It is important to train immune systems from a young age to deal with pathogens in the environment, viruses and bacteria in order to be able to battle diseases naturally and to tell the difference between good and bad in the system. By constantly over-sanitising ourselves, bacteria tend to develop a resistance causing an overt reaction to it. If you had met all these viruses and bacteria when you were a child, you would not have an increased response to this. Increased sanitation can be a downside."

Nakazawa believes a simple three-step process can help us make small but effective changes to our lifestyle, health and immediate environment. "Ask yourself — What am I breathing? What am I touching? And what am I consuming?" she says. "Using these simple questions, go over what you're buying, read up the labels, check for greener and more organic products, eliminate chemicals and reduce the rate of consumption by only buying or consuming what you need. Monitor your health and become more active. For those with autoimmune disorder, I've found that being part of a support group and being able to positively share your journey with others is immensely useful and empowering."