AUTOIMMUNE DISEASE AND WOMEN
There are more than 100 different autoimmune diseases. Autoimmunity occurs when the body’s immune system becomes misdirected and attacks the very organs it was designed to protect. According to the American Autoimmune Related Diseases Association, 1 in 6 people are affected with 75% being women. The number of women with autoimmune diseases is increasing every year, currently making it the 4th largest cause of disability and 8th leading cause of death for women ages 15-64 in the United States.
While researchers are still attempting to identify the underlying causes, we do have some insight as to why women appear to be more impacted. Hormones and inflammation play a key role in the development of autoimmune diseases. Estrogen predisposes women and when there are significant changes, such as during/after pregnancy or menopause, women become even more susceptible. Another observation by research is that autoimmune diseases tend to cluster within families. For example, a mother may have multiple sclerosis with her daughter having juvenile diabetes and the grandmother having rheumatoid arthritis: All different forms of autoimmune diseases.
Due to the initial symptoms being sporadic and rather generalized, autoimmune diseases are difficult to diagnose until the disease becomes more acute. General medical providers receive minimal education about these diseases, which contribute to poor early diagnoses. In order to get an accurate diagnosis of which autoimmune disease is occurring, there often needs to be collaboration among specialists, such as an Endocrinologist, Gastroenterologist and/or Rheumatologist. This may require the patient to be their own advocate if the general provider is hesitant to refer.
In a number of autoimmune diseases, difficulty swallowing (also known as Dysphagia) can be the presenting symptom. Typically it presents as a feeling of food being “stuck” in the throat or chest area. This is more specifically known as Esophageal Dysphagia, as the esophagus (your food pipe) plays a primary role in the swallow impairment. So what is the underlying cause within these autoimmune diseases that would cause swallowing problems in the first place?
There are three key areas that autoimmune diseases impact which ultimately can impact the swallow: Connective tissue (e.g., Scleroderma, polymyositis, Lupus), bone (e.g., rheumatoid arthritis, ankylosing spondylitis) and the thyroid (e.g., multiple sclerosis, Graves Disease, Hashimotos).
With autoimmune diseases that involve connective tissue, gastro-esophageal disease (GERD) can be the result of an improper closing of the sphincter between the stomach and the esophagus. When the stomach contents reflux up the food pipe due to the poor ability of the sphincter to close, this can create a host of swallowing problems. The acids from the stomach can damage the lining in the food pipe over a long period of time and create deformities. This can result in food getting stuck trying to pass them on the way down to the stomach. Another possibility with connective tissue disease is Achalasia. This is where nerves in the esophagus become damaged and over time can paralyze its ability to squeeze food down into the stomach. Food then becomes trapped in the esophagus, which can ferment and eventually come back up into the mouth. This can be mistaken for GERD due to the bitter taste. However, in achalasia the food is coming from the esophagus, whereas in GERD the material comes from the stomach.
Bone loss and complications can affect the structure of the swallow, particularly with severe forms of osteoporosis. Often, patients may be treated with steroids or Bisphosphonates for their bone loss problems. These medications can increase the presence of reflux, which as discussed can wreak havoc on the esophagus lining over time.
When the thyroid is impacted, swallowing difficulties can appear as a result of nerve involvement from direct compression of an enlarged gland. Often, the thyroid is treated by methods of medication, surgery and/or radiation. Side effects from any of these treatment methods can also result in dysphagia.
Understanding the relationship between swallowing difficulties and autoimmune diseases can greater assist with an early diagnosis. While there is still much to learn about prevention and cures, consulting with a clinical nutritionist once an accurate diagnosis is made is becoming a very effective way to better manage the disease process. Mediterranean or low glycemic diets are being researched as well as supplements such as omega 3 fatty acids and turmeric with good outcomes. If you are having swallowing difficulties, please have your doctor refer you to a speech therapist that specializes in dysphagia. The speech therapist can be an excellent resource for how to better manage your swallowing difficulties and possibly rehabilitate weakened areas depending on the underlying issue.