The connective tissues are fabric-like substances that form a matrix that wraps and fills all the spaces in the body, even extending into the innermost parts of cells. All the major bodily systems–the circulatory system, the nervous system, the digestive tract, the musculoskeletal system, and each individual organ–are surrounded and supported by the various forms of connective and related protective tissues (epimysium, perimysium, fascicle, endomysium etc.)
With the exception of cartilage, all the connective tissues are highly vascular. Collagen is a fibrous, insoluble protein in connective tissue. It represents about 30% of the total body protein. The diseases that affect this tissue are collectively known as connective tissue disease (CTD), or sometimes collagen vascular diseases.
These include systemic lupus erythematosus (SLE), scleroderma, rheumatoid arthritis, and combinations of these three diseases, called mixed connective tissue diseases or MCTD’s. They share many characteristics, so the herbal treatments discussed here can be used for all these problems, although important differences cannot be neglected.
Rheumatoid arthritis is characterized by fatigue, weakness, and gradually intensifying joint pain. The pain usually begins in the small joints, eventually affecting all the joints in the body. It is an extremely painful and disfiguring condition.
Lupus (SLE) is an inflammatory CTD that occurs predominantly in young women–90% of all cases are diagnosed in this portion of the population. Although it can develop slowly over time, lupus often starts with a fever or acute infection. Most patients complain of arthritis-like pain, swelling, and skin inflammation, and there is often a characteristic butterfly-shaped reddening on the cheeks.
Lupus can spread to the brain, kidneys, lymph glands, lungs and other tissues. There is a strong suspicion that part of the cause involves hormonal abnormality. For example, there is a higher incidence of the disease in women taking synthetic estrogen supplements (Sanchez-Guerrero et al 1995). Patients should avoid prolonged sun exposure as it often exacerbates the disease.
You can visualize the effects of lupus on the body here.
Scleroderma is a CTD disease characterized by progressive thickening and stiffening of the skin, followed by atrophy and changes in pigmentation. It can progress to the internal organs, eventually leading to death.
Treatment of Autoimmune and CTD’s – Different Perspectives
The high level of inflammation and tissue destruction that occurs with CTD’s points clearly to a weakness in the body’s detoxification systems and resultant accumulations in the tissues that precipate immune attack. And the fact that the protective connective tissue is so often right in the middle of things is a key insight.
This is a key difference in the thinking of natural medicine doctors and pharmaceutical based medicine. Almost the entire focus of doctors is to use steroids and biological modifiers to try to turn off the immune system attack on the tissues, either the entire immune system or any one or more of its various parts, or to rev up parts of the immune system.
This approach is very frustrating for both doctors and patients, because, while it can definitely turn off tissue destruction for periods of time and protect the patient, the immune system almost always finds a new way to accomplish its “inflammatory” tasks and in the process many side effects occur.
Here, for example, is a Medscape continuing education course for physicians that focusses almost exclusively on biologics, drugs to target the immune system, with hardly a word about why the immune system is attacking in the first place.
Don’t misunderstand. The seriousness of these diseases often necessitates concomitant use of strong Western anti-inflammatories such as prednisone and biologic medicines when a patient is in crisis. These medicines -such as monoclonal antibodies, interferon, IL-2 and colony-stimulating factors -powerfully turn things ups and down, and can be life saving.
But, the main question I want to discuss in this article is WHY the immune system is attacking in the first place. Is the immune system just an out of control system that starts to attack the body for no reason? Or are there reasons that we can modify beyond just targeting the immune system?
What do you think?
Why the Connective Tissue?
Why is the protective connective tissue (discounting genetic disorders) so often the focus of the immune attacks?
First of all, just as the discovery of the virus erased the supposed dividing line between “life” and “non-life,” scientists are now moving away from the traditional rigid view of the body as a collection of separate cell units with distinctly different functions. As they delve deeper into the physical tissue, it is possible to find the same or similar patterns, tissue types and functions repeating themselves at all levels.
To understand the connective tissues, the main focus of immune attacks, you must realize that it is elastic and supportive. Moreover, it is not found just in our fibrous well-known “gristle.” Connective tissue proteins are also found within cells in the contractile filaments, stiff tubes and connecting trabeculae, and some even surrounds the genetic material (Oschman 1986).
And most importantly, it provides structure and protection to the entire body.
In that sense, autoimmune and connective tissue diseases are the body going after its own structural components trying continuously and often unsuccessfully to remove something it does not want to be there, i.e. antigens.
The Natural Medicine Approach
I like to tell my patients that I am not trying to swat all the insects flying around in the room, I am trying to find and fix the holes in the screens.
For example, symptoms of weakness, or alteration in blood chemistry parameters of patients often indicate a need for immune and general tonification, as well as additional support of the digestive system.
This flies in the face of conventional wisdom that you want to avoid “immune stimulating” herbs. Rather a strong immune system will often react more moderately and appropriately than a weak immune system. Well known herbalists such as Michael Tierra, Roy Upton, Kerry Bone and David Winston have all spoken about this to me.
But this approach is not universal, there are some caveats especially in hypersensitive individuals (another well know herbalist, Paul Bergner, has cases of this problem from his clinic), so its best to consult with a professional herbalist if you go down this path.
The swelling and pain often found dictate a need to remove dampness and blockage. This can be accomplished relatively easily with periodic fasting, or with TCM or Ayurvedic herbs.
And the buildup of antigen-antibody complexes points to finding ways to remove the antigens – toxins, viruses, bacteria – an antigen is just a “harmful substance.” Enzyme therapies such as bromelian can break up these complexes gradually, which will calm down the immune system as the antigens are removed. For example, I have used enzymes to reduce TPO antibodies in hypothyroid patients, as confirmed by labs.
In other words, I am not focussing on forcing the immune system to stop attacking the tissues, but rather I am focusing on removing the dietary, infectious and toxic underlying issues that make the immune system attack in the first place.
Understanding More
Nutritional experts emphasize the need to check for poor diet and food allergies. Many autoimmune patients benefit from dietary elimination of cow’s milk products, wheat, oats, barley, rye, and grains containing the proteins gluten and gliadin.
As in most inflammatory diseases, Omega-3’s from fish and flaxseed oils are often used to treat CTDs. Long-term use of borage oil has also been shown to benefit rheumatoid arthritis patients (Zurrier, 1996). The combination of boths oils together has been reported effective by numerous practitioners (reported in Bland, 2000).
According to Jonathan Wright, MD, author of the Nutrition & Healing Newsletter, digestive weakness is very common. He says, “I can’t remember the last time I saw someone with lupus who had a normal stomach test; usually there is no stomach acid and pepsin at all, or very little. Replacement hydrochloric acid and pepsin capsules are almost always necessary” (Wright 1999).
In my own practice at our Delaware clinic, I have found that beyond just poor diet, many autoimmune patients have severe intestinal dysbiosis, and properly treating it brings down the inflammation quite a lot, in some cases to a remarkable degree.
Hollywood news media reports in 1999 claimed that actor James Coburn recovered from a severe case of RA using a nutritional supplement called MSM. MSM is an easily assimilated food source of nutritional sulfur that helps strengthen connective tissue.
MSM has captured interest among the nutritional science community because of its ability to strengthen and maintain joints and collagen structures. It is also a scavenger for free radicals and foreign proteins. Patients usually use 1,500 mg of MSM twice a day. Initial onset of action is typically three to six weeks, with maximum benefits seen at three months. I have used it with moderate success. It sometimes works very well, and sometimes does not work at all.
TCM expert Bob Flaws wrote a very interesting piece on a Mainland China TCM treatment for SLE. He reported that most of his patients had wind, damp, and heat blockages, liver energy blockage, kidney Yin and/or digestive energy (Spleen Qi) weakness, and sometimes blood stasis (Flaws 1999).
He used complex formulas that would require formulation by a professional TCM practitioner according to signs and symptoms. I would agree, and my clinical experience confirms that these problems require complex and long-term guidance under a professional. Any suggestions I make here (and elsewhere, for that matter) should not be seen as panaceas.
TAM doctors suggest using anti-inflammatory herbs, along with laxative, diuretic and digestive herbs, for six months or longer. Effective anti-inflammatory herbs include triphala, guggul gum, and guduchi stem. Interestingly, they also use plasters that contain sulphur— MSM cream would perhaps be the modern equivalent. One unique medicine that may be of benefit is narayana taila, a complex Ayurvedic medicated oil also used to treat osteoarthritis.
Antibiotic treatment with minocycline has been shown effective in rheumatoid arthritis, lending credence to the idea that there may be an unknown infectious component to CTD’s (Kawanaka N et al. 1998). In fact allopathic doctors are increasingly using two antibiotics, sulfasalazine and minocycline, that have been shown effective in treating rheumatoid arthritis. I have seen Dr. David Jezyk, a holistic MD, put rheumatoid arthritis patients into temporary remission using these medicines.
This method seems to only work in a percentage of patients, perhaps about 1/3. This treatment can serve as a good beginning for a holistic program. Along similar lines, and as a result of my own experiences in developing protocols for MS (another autoimmune disease), I have concluded as mentioned earlier, that immune system tonification is an important component of treatment. I often use herbs like ginseng root and astragalus root.
Dietary counseling is essential. I often find that the diet for heat and dampness is the best choice. The exercises of T’ai Chi and Yoga, combined with “breathwork” such as Qi gong and Pranayama, work to restore energy and elasticity directly to this tissue and are therefore fundamental to the treatment of CTD’s.
I treat CTD patients by first helping them to understand the importance of strict dietary control as outlined above. I think it is important for patients to accept the fact that CTD’s do not respond to “quick fix” methods. I then formulate at least two long-term herbal combinations, choosing herbs primarily from the following lists, emphasizing different herbs depending on the patient’s signs and symptoms. My choices are highly individualized.
And I want to emphasize again that many of my patients require steroids and biologic medicines from their doctors to keep things under control. Over time sometime the prescription medicines can be slowly reduced.
How I treat Autoimmune diseases at my clinic
Simple put, first I work with the patient to remove whatever underlying issues I find, digestive, liver, nutritional etc – this by itself can take a few months.
Then I put together a group of interrelated supplements to restore the immune system to normal, and to repair existing damage. This can take months longer, even up to a year.
The hardest thing for people to understand is the timing.
Prescription biologics that suppress tumor necrosis factor (TNF) like Humira, Enbrel and Remicaid are used to treat diseases like rheumatoid arthritis (RA), juvenile arthritis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis, ulcerative colitis (UC), and Crohn’s disease. They typically take 2-3 months to bring down the inflammation to a decent level.
Herbal medicines that reduce TNF, such curcumin, boswellia and phellodendron do the same thing with much lower side effects, but can take from 3-9 months to work. This requires patience, but it is well worth the wait for many people
Herbs for treating CTDs and Autoimmune diseases
To strengthen the body’s own anti-oxidant status and liver removal of toxins, choose from amla fruit, dandelion root, milk thistle seed, wheat sprouts, and white peony root.
• I often use two or three grams of concentrated wheat sprouts for a minimum of six weeks early in the therapy.
• To directly remove inflammation and swelling, make a combination of herbs that reduce heat or heat and dampness such as ashwaghanda root, boswellia gum, honeysuckle flower, licorice root, raw rehmannia root, rhubarb root, willow bark, guduchi stem, and turmeric root (concentrated to be high in curcumin)
• Essential fatty acids (Omega-3 fish oils or flaxseed oil) are critical to use
• To modulate the immune system and reduce autoimmune attack, assuming the patient cannot tolerate biologics, use either (a) low-dose prednisone (b) high doses of vitamin D3. This part of the protocol is critical, not as an end in itself, but to buy time for the cleansing and dietary therapies to work.
• For digestive support and to help the body eliminate protein or sticky deposits, use high doses of digestive enzymes These should be used along with guduchi stem or kaishore guggul.
• To remove dampness and swelling, choose from black atractylodes, coix, dandelion leaf, and phellodendron bark.
• To strengthen the connective tissue itself, choose from herbs and nutrients like glucosamine sulfate, gotu kola leaf, bamboo sap (Bambusa species), flavonoid-rich fruits, multi-mineral combinations, hawthorn, stoneroot and MSM. In scleroderma cases, MSM is also useful topically, as a cream.
Combinations of these herbs must be used in moderate to high doses for a long period of time, and chosen and adjusted according to patient response.
You can add breathing and stretching exercises to the regimen once the patient has progressed enough to do them comfortably.
Acupuncture can be helpful.
Although we have not succeeded in completely reversing all CTD’s, many of our patients have experienced slow progress and a noticeable reduction in symptoms greater than when on prescription drugs alone.
We have put some fortunate patients into long term remission.
The difficulty of these diseases requires persistence and discipline from the patient, and humbleness and constant study and focussed study and learning from the doctor.