Do you have worsening fatigue, headache, brain fog, problems with mood and concentration, physical pain, or unsteadiness, but your medical team can’t find anything wrong with you? Maybe you have some mild elevation of autoantibodies, but not enough for doctors to come up with a diagnosis. Your doctors may be reassuring, but you know your immune cells should not be attacking and damaging parts of your body. Or maybe you have migraines, chronic pain, unexplained fatigue or other unexplained symptoms.

All of these issues–low-level autoantibodies, migraines, chronic pain, unexplained fatigue–are part of a prodrome for developing a serious autoimmune condition such as multiple sclerosis, rheumatoid arthritis, inflammatory bowel disease, or any of the hundreds of other autoimmune conditions that have been described ^{[1, 2, 3, 4]}.

Studies of military personnel who have frozen serum during their service (allowing comparison of their immune status over time) have demonstrated that this prodromal phase is a reality. For rheumatoid arthritis, the Anti-Citrullinated Peptide (an autoantibody) is present for up to 13 years before diagnosis of the disease. For lupus, the antibody can be present for up to 9 years. For Sjogren’s, it can take 7 years, for MS, 3 years ^[5].

You don’t have to watch and wait–you can stop your body from continuing to damage your cells now. You can address the root cause of autoantibodies and slow or stop the descent into a disease state. Here are the top five things you can do right now.

1. KNOW YOUR VITAMIN D LEVEL

Having your vitamin D level in the top half of the reference range is correlated with fewer symptoms in many autoimmune diseases.^[6] In MS, levels greater than 40 are associated with less brain volume loss and fewer relapses. You can use your skin to make more vitamin D or take vitamin D supplements. If you take supplements, be sure to monitor your levels through regular testing.

2. IMPROVE SLEEP

Sleep disorders are associated with higher risk for developing autoimmune issues ^[7]. Go to bed at a consistent time and wake up at a consistent time. Aim for 7 to 9 hours of sleep each night. Insufficient sleep increases the likelihood of excessive cortisol and abnormal immune function, which increases the risk of autoimmune disease. If you are not sleeping well, snore, or do not awaken refreshed, consider getting a sleep evaluation.

3. TRY A GLUTEN-FREE, DAIRY-FREE DIET

Consider a trial of a gluten-free and dairy-free diet to see what effect that has on your symptoms. Following a gluten-free and dairy-free diet has been demonstrated to be helpful in small case series or pilot studies in the setting of multiple sclerosis [8], pelvic pain, endometriosis, and infertility ^{[9, 10]}, migraines ^[11], and irritable bowel ^[12]. Undiagnosed food sensitivities can cause leaky gut, where incompletely digested food particles can enter the bloodstream, causing the body to mount an immune response and increase inflammation molecules in your bloodstream. This in turn may lead to an increase in pain and fatigue. Go at least two weeks without gluten and dairy to see if your symptoms lessen or change.

4. IMPROVE NUTRITION

The vast majority of patients with multiple sclerosis do not eat 3 servings of vegetables a day, which mirrors the typical westernized diet ^[13]. Many eat less than two servings of vegetables a day, relying instead on fast food and processed foods. Diet quality is linked with the severity of disability and quality of life in multiple sclerosis ^{[14, 15]}. Improve your symptoms by improving your nutrition. Begin cooking meals at home, using ingredients and recipes. Eat more non-starchy vegetables, especially green leafy vegetables and cabbage family vegetables.

5. REDUCE SITTING TIME AND MOVE MORE

Physical activity is an important risk for multiple sclerosis disease severity and progression ^[16]. Lower rates of activity increase the risk of autoimmunity and dementia. Move more—physical activity stimulates your muscles as well as the brain and can improve mood and contribute to better sleep. Tailor your activity level to your energy level—any movement is better than none.

Even if you don’t have a specific autoimmune diagnosis, having any of these prodrome symptoms or diagnoses suggests you are at higher risk of an autoimmune diagnosis. I suffered for decades with relentlessly worsening trigeminal neuralgia. I’d had migraines for years before I had trigeminal neuralgia. I had endometriosis and infertility for years before I developed autoantibodies, and I had autoantibodies for years before I developed multiple sclerosis. Finally, I developed leg weakness that was diagnosed as multiple sclerosis. After that, I experienced relentless decline.

Don’t wait until you develop a progressive autoimmune disease for which there is no cure. Begin now. Pick one of these steps and gradually implement it to get better control of your prodromal issues before you develop an autoimmune diagnosis. I so wish I’d known that my symptoms suggested that I was likely to develop an autoimmune diagnosis, and that there were things I could have done to lower my risk. If I were you, I would do all you can to reduce yours.

I have created a course to teach people at risk of developing autoimmunity how to reverse the prodrome symptoms. It teaches people how to recognize the environmental factors that contribute to developing autoimmune disease states, and, most importantly, what you can do to stop the damage. Following these steps often reduces fatigue, headaches, and brain fog and improves mood. If you have issues with migraines, pelvic pain, endometriosis, or infertility, these steps can also help. There is so much you can do right now to improve your health and prevent decline.

The Autoimmune Intervention Mastery Course (AIM), offers a deeper understanding of why autoimmune disease develops and specific steps you can take to restore health. For those with an autoimmune prodrome, completing the AIM course often leads to regression of symptoms entirely, including a steady lowering of the autoantibody levels. Pain resolves. Fatigue resolves. Joy returns. Life is fully restored.

It is the best investment you can make for your future self! Begin today!

 

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References:

1. The Multiple sclerosis prodrome: Emerging evidence, challenges, and opportunities.Tremlett H, Marrie RA Mult Scler. 2021 Jan;27(1):6-12. doi: 10.1177/1352458520914844. Epub 2020 Mar 31.
2. Prodrome in relapsing-remitting and primary progressive multiple sclerosis./a>Wijnands JMA, Zhu F, Kingwell E, Zhao Y, Evans C, Fisk JD, Marrie RA, Tremlett H.Eur J Neurol. 2019 Jul;26(7):1032-1036. doi: 10.1111/ene.13925. Epub 2019 Mar 1.PMID: 30714270
3. Rheumatoid Arthritis Pathogenesis, Prediction, and Prevention: An Emerging Paradigm Shift. Deanne KD, Holer VM. Arthritis Rheumatol. 2021 Feb;73(2):181-193. doi: 10.1002/art.41417. Epub 2020 Dec 8.
4. Depression in inflammatory bowel disease: risk factor, prodrome or extraintestinal manifestation? Mouton CD,  Norton C et.a. Gut. 2020 Mar;69(3):609-610.doi: 10.1136/gutjnl-2019-318444. Epub 2019 Feb 26.
5. Development of autoantibodies before the clinical onset of systemic lupus erythematosus.  Arbuckle MR, McClain MT, et al. N Engl J Med. 2003 Oct 16;349(16):1526-33.doi: 10.1056/NEJMoa021933.
6. Emerging role of vitamin D in autoimmune diseases: An update on evidence and therapeutic implications. Murdaca G. et al. Autoimmun Rev. 2019 Sep;18(9):102350. doi: 10.1016/j.autrev.2019.102350. Epub 2019 Jul 16.
7. Sleep disorders and increased risk of autoimmune diseases in individuals without sleep apnea. Hsiao YN et al. Sleep. 2015 Apr 1;38(4):581-6.doi: 10.5665/sleep.4574.
8. Effects of a multimodal intervention on gait and balance of subjects with progressive multiple sclerosis: a prospective longitudinal pilot study. Bisht B, Darling WG, White EC, et al. Degener Neurol Neuromuscul Dis. 2017;7:79-93.
9. Do celiac disease and non-celiac gluten sensitivity have the same effects on reproductive disorders? Pieczyńska J.
10. Role of Gluten-Free Diet in the Management of Chronic Pelvic Pain of Deep Infiltrating Endometriosis. MarzialiM,  Capozzolo T. J Minim Invasive Gynecol. Nov-Dec 2015;22(6S):S51-S52. doi: 10.1016/j.jmig.2015.08.142. Epub 2015 Oct 15.
11. The Clinical Use of IgG Food Sensitivity Testing with Migraine Headache Patients: a Literature Revie. Alpay K, Ertas  M,  Orhan EK, Ustay OK,et al.Curr Pain Headache Rep. 2019 Aug 27;23(11):79. doi: 10.1007/s11916-019-0819-4.
12. Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial. AtkinsonW,  Sheldon TA,  Shaath N,  Whorwell PJ. Gut. 2004 Oct;53(10):1459-64. doi: 10.1136/gut.2003.037697.
13. A survey of dietary characteristics in a large population of people with multiple sclerosis. Fitzgerald KC, Tyry T, Salter A, et al. Mult Scler Relat Disord. 2018;22:12-18.
14. Does a modifiable risk factor score predict disability worsening in people with multiple sclerosis? Marck CH, Aitken Z, Simpson S, Weiland TJ, Jelinek GA. Multiple sclerosis journal – experimental, translational and clinical. 2019;5(4):2055217319881769.
15. Associations of Lifestyle, Medication, and Socio-Demographic Factors with Disability in People with Multiple Sclerosis: An International Cross-Sectional Study. Jelinek GA, De Livera AM, Marck CH, et al. PLoS One.2016;11(8):e0161701.
16. Lifestyle-based modifiable risk factors in multiple sclerosis: review of experimental and clinical findings. Jakinmosvski D et al. Neurodegener Dis Manag. 2019 Jun;9(3):149-172. doi: 10.2217/nmt-2018-0046. Epub 2019 May 22.