CPD – Podcast, FX Medicine: Multiple Autoimmune Syndrome. Notes: Autoimmune disease tends to develop in clusters with about 25% of patients with multiple autoimmune syndrome (MAS). Educating patients on the possibility of this is important, however care must be taken to reduce undue stress by providing holistic support, early intervention, and other avenues that traditional western practices can overlook. • Focus on the issue of immune dysregulation/dysfunction, the impact of sleep/stress etc, and not only where the tissue is being attacked. Getting patients on board via education is also critical not only for understanding the health picture but to shift patient thinking to a “solutions focused” one rather than feeling helpless. • Awareness of rogue symptoms can assist with better management I.e., sore joints, headache, fatigue, any symptoms that seem unrelated but exacerbate inflammation and warrant a deeper look. • Although not well known, MAS Types can be classified (see paper in resources): • Type 1 – Presenting with myasthenia gravis, thymoma polymyositis, and giant cell myocarditis. Rarest type • Type 2 – Presenting with any combination of Sjogren’s syndrome, RA, primary biliary cirrhosis, scleroderma, and autoimmune thyroid disease. Most common. • Type 3 – Autoimmune thyroid, myasthenia, Sjogren’s, pernicious anemia, thrombocytopenia, Addison’s, type one diabetes, vitiligo. • When screening Anti-nuclear antibodies (ANA) and extractable nuclear antigens (ENA) the naturopath’s role is to see the trend in decline of results and intervene to work toward homeostasis earlier rather than wait for the clinical criteria to be met where health may be severely impacted. • Pathologies and testing for MAS may include but not limited to full blood count where a focus on T-cells can aid with tracking immune health. GIT and microbiome testing can assist with underlying inflammatory drivers (dysbiosis, gut permeability and dietary antigens). Mold toxicity must also be considered as an underlying environmental driver. • The use of remission stories can help shift a patient’s outlook on their health and provide them with hope. Revisiting initial consult data and checking in on their current status can help to show progression. • Rebuilding healthy sleep and lifestyle patterns can positively impact the immune system’s T-cells and their individual circadian rhythm, ultimately influencing the maladapted immune system in MAS patients. Lifestyle supportive aspects include time in nature (grounding, sunlight exposure). Nurturing through nature supports activation of anti-inflammatory genes, exposure to phenolic acids, essential oils, exposure to a diverse soil microbial, social interactions can all positively impact immune health. • Investigations into common dietary antigens can be helpful in reducing exposure to molecular mimicry effects that can further trigger autoimmune pathways. • Improving vagus nerve tone for improving gut and brain communication, which can assist with managing stress reducing the likelihood of further disease developing. • Novel treatment with peptides show promise. New compelling research using peptides (regulated for use by approved practitioners in USA, but not TGA approved in Australia) to support autoimmune mechanisms is emerging. • The class of peptides thymosin alpha-1, thymosin beta-4 or TB500 may alter thymus gland function where atrophy or involution are present. Thymus atrophy differs from involution. Thymus atrophy is typically due to nutrition status, hormonal levels, adrenal health. Thymic involution is typically age-related and non-reversible. Nutritional support for MAS • Vitamin D alone may not be enough. Vitamin-A is also required for optimal vit-D binding and activity to the retinol dependant VDR, RXR receptor complex. The optimal ratio to support this mechanism is that of 10 to 1 – cod liver oil naturally contains this ratio. • Medicinal mushrooms and their beta-glucan content may assist with (underlying stealth) infections • Glutathione for use mid treatment modulates T1, T2 and T17 cells, supports detoxification while supporting antioxidant pathways. Begin at 5ml/d up to 20ml/d in divided doses for flare ups. • Herbal support with immune modulatory, immune boosting, adaptogenic and nervines can be considered. • Microbiome support with L. Paracasei LP33 and lactobacillus rhamnosus GG (LGG) shown to support T-regulatory cell function and modulate TH17. • EGCG (Epigallocatechin Gallate) can also act as a dietary antioxidant support