Expert discusses relationship between autoimmune disease, diabetes, CVD

Many of the risk factors for heart disease, including high BP, high LDL, smoking and obesity, are well-known, but some, such as autoimmune disease, are not.

Autoimmune disease is most likely to increase risk for heart disease in patients with diabetes, according to Chad Larson, NMD, DC, a naturopathic medicine physician and chiropractor in private practice who spoke to Cardiology Today as part of a campaign to raise awareness of the connection during American Heart Month.

Q: What is the relationship between autoimmunity and diabetes?

A: Type 1 diabetes is an autoimmune condition where there’s an autoimmune damage to the beta cells of the pancreas, where insulin is produced. It inhibits the pancreas from making insulin, and insulin allows sugar or glucose to get from the bloodstream into all the cells of the body. Glucose can’t just go in by itself. Type 2 diabetes is typically noninsulin-dependent and the pancreas makes plenty of insulin — in fact, insulin is usually elevated in type 2 because type 2 is insulin-resistant at the cellular level, not the pancreas. Probably due to a variety of certain failures in lifestyle and dietary habits, the cells have become resistant to insulin. If we think of insulin as the key that opens the lock so the glucose can go in there, in insulin-resistant diabetes, the cell no longer accepts the key of insulin, so glucose stays in the bloodstream and its levels rise; high glucose is one of the first signs we see on a lab test that a person has diabetes.

Chad Larson

But, there’s a little gray area that’s happening and we are understanding more and more about it. A certain percentage of people who have what we call type 2 or insulin-resistant diabetes develop an autoimmune component to their diabetes. In other words, they start to experience destruction of their beta cells and their insulin. Typically, type 1 diabetes is diagnosed when they’re young, about teenagers, but there’s actually a double-peak of diagnoses: There’s the early one and there is also one later in life. The people that would otherwise be considered type 2 who have at least a component where it’s autoimmune, sometimes we will call their condition “diabetes 1.5” because it’s a little bit of both. Technically, we call it LADA — latent autoimmune diabetes of the adult. It’s an autoimmune process that develops later in life.

Q: How does this autoimmune process that’s tied in with diabetes impact heart disease?

A: A person who has diabetes has a dramatically increased risk factor for CVD, CHD and stroke. There’s a dramatic increased risk when a person has diabetes because of their blood sugar dysregulation. The reason why the body works so hard to get glucose out the bloodstream and into the cells is because in the cells is where energy is made. When glucose is in the blood, it’s quite destructive, because when it’s floating around in the bloodstream it can create a lot of problems. One of them is called glycosylated end products, which are destructive compounds that could start to affect the health of the arteries.

When a person has diabetes, they don’t usually die of diabetes, but the life expectancy of somebody with diabetes is shortened compared with the rest of the population, not because of diabetes directly but because of the indirect impact it has on the CV system. So what people with diabetes often die from is heart disease, and it’s because of this blood sugar problem: There is too much glucose in the bloodstream and it starts to cause damage to the blood vessels. This happens over a period of time until it manifests into heart disease. Basically, it is just blood sugar forming these glycosylated end products that cause heart disease.

Q: How can autoimmune reactivity be controlled and what is the impact of controlling it on diabetes and heart disease?

A: An autoimmune process is where the body’s own immune system is mistakenly targeting an otherwise healthy organ and causing destruction to that organ. In the pancreas, that turns into diabetes, in the joints that turns into rheumatoid arthritis, in the thyroid it might turn into Hashimoto’s thyroiditis; in the brain, it might be multiple sclerosis. The autoimmune disease manifests depending on where the immune system is targeting. What the literature tells us is if we can identify and remove the trigger to that autoimmune process, then the autoimmunity itself should go into remission.

To take a really black and white example, celiac disease is an autoimmune process of the gastrointestinal tracts in the small intestine that causes life-threatening destruction of the small intestine. We happen to know the underlying trigger for that: gluten from wheat. It’s a protein that causes the immune system to mistakenly target the small intestine. Removing gluten from the diet causes celiac disease to go into remission: a key word because the patient’s autoimmune condition never goes away; if they were to go back on gluten again, it would come right back. In diabetes, or any other autoimmune process for that matter, if we can identify that individual trigger to that autoimmunity and remove it, then the patient’s autoimmunity can go into remission. While it is very black and white with celiac disease, in most other autoimmune conditions it’s going to vary from person to person. But the general categories that we consider are dietary protein, proteins from grains or from eggs or from dairy, soy, etc. In another category, certain environmental chemicals have been known to cause this kind of immune system dysregulation involving the attacking of organs. No. 3 on this list is pathogens. There are a whole variety of pathogens that have been identified that can lead to autoimmunity.

So, when we have a patient with an autoimmune condition, such as autoimmune diabetes, we try to go down that list to try and figure out what their body is reacting to, and then we remove that trigger and see if that helps their autoimmune activity go down. If we can do that in diabetes, then that’s going to be a reduction in a major risk factor for heart disease.

Q: What else can doctors do to help prevent their patients who have autoimmunity issues, and perhaps autoimmune diabetes, from getting heart disease?

A: First, we just have to understand that connection, which unfortunately isn’t totally embraced by a lot of medical providers where they aren’t understanding the connection between certain environmental triggers like dietary proteins, chemicals and pathogens, and the manifestation of autoimmunity in their patients. Then we must learn how to evaluate for those triggers. The lab I use (Cyrex Laboratories) has panels for dietary proteins, chemicals and pathogens all in one place, which is helpful because we used to have to put together reports from multiple labs to come up with the right conclusion related to all these factors.

So, the first step is to understand the connection between autoimmune conditions and other conditions, and the next step is to start testing patients who have autoimmune conditions to try to identify and remove the triggers that are present. – by Erik Swain

Disclosure: Larson reports consulting and advising for Cyrex Laboratories.