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Li's memoir puts autoimmune disease under microscope; she'll read from the book Nov. 4 at Powell's in Beaverton

COURTESY PHOTO - CYNTHIA LIAs a doctor, Cynthia Li, knows what she's talking about when it comes to autoimmune diseases. As a patient, she embarked on an unconventional path to healing her specific type of autoimmune disease, one that manifested as chronic fatigue syndrome and dysautonomia.

Many of Li's ideas about doctors and medicine were challenged by her illness.

She reads from her new book "Brave New Medicine, A Doctor's Unconventional Path to Healing Her Autoimmune Illness" ($18.95, New Harbinger Publications), 7 p.m. Monday, Nov. 4 at Powell's at Cedar Hills Crossing in Beaverton.

Li is a private practice doctor in Berkeley, California, specializing in integrative and functional medicine and serves as faculty for the Healer's Art program at the University of California San Francisco Medical School. In the past, she's also volunteered with Doctors Without Borders in rural China, focusing on HIV/AIDS care.

The Tribune caught up with Li to discuss autoimmune disease, recovery and more:

COURTESY PHOTO - Cynthia Li's book, 'Brave New Medicine'Tribune: What are some of the major misconceptions about autoimmune diseases?

Li: That they're irreversible, and there's nothing you can do; they're your fault (self-attacking self); and that if your lab tests are normal, that this means you must feel well, too.

Tribune: Your story is so compelling. Each doctor reports that your test results are normal. How did you find a path out of this cycle and what was the ultimate "name" given for your illness?

Li: Chronic fatigue syndrome and dysautonomia. Although the postpartum thyroiditis turned into Hashimoto's thyroiditis, too. The two syndromes really didn't mean anything, except to explain what I was feeling.

So, this forced me to explore other ways of healing, since there weren't any ways to treat the conditions with drugs. I didn't want drugs anyhow, and wouldn't have been able to tolerate them.

Tribune: What one thing would you most like to communicate to people about healing their autoimmune disease?

Li: It's possible to reduce or reverse autoimmunity. And, in some cases, if the underlying root causes are identified and addressed, to cure it. The contributors to autoimmunity can be complex and numerous. But, this also offers multiple ways to begin addressing them.

Tribune: Has bias played a role in the research of autoimmune disease? Because such illnesses affect more women than men have they been less researched by the medical establishment?

Li: According to the American Autoimmune Related Diseases Association (AARDA), autoimmunity (the combination of all the different diseases) is the No. 2 cause of chronic illness after cardiovascular disease. Nonetheless, the level of basic research for autoimmune diseases is less than 3% of the budget of the National Institutes of Health.

In my opinion, this could be due in part to the gender bias — women are affected by autoimmunity more than men, often two to four times, and in lupus, it's an overwhelming ninefold increase — and the gender bias in clinical trials and studies has been a well-established trend. It improving, but there's still a gap.

Tribune: Are autoimmune diseases on the rise? If so, why?

Li: Yes, they have been on a steep rise since the 1950s. We've long known that genes play a role. While they don't fate someone to develop an autoimmune disease, certain genes can confer a higher risk for particular conditions.

That said, when one identical twin develops Hashimoto's thyroiditis, the second-most common autoimmune disease after rheumatoid arthritis, her twin only has a 50% chance of developing the disease. Much of it, therefore, is environment-dependent.

"Environment" refers to a cumulative exposure over an individual's lifespan. In functional medicine, we look at environmental pollutants (like mercury and pesticides), allergens (like gluten and dairy), infections (like Epstein-Barr virus and Lyme), stress (emotional, mental and physical trauma), and diet (processed fats and sugars, nutrient-deficiencies).

Hormones play a role, too, which renders women more susceptible, and especially around times of large fluctuations like the postpartum period.

In addition, recent research from Alessio Fasano, a researcher at Harvard University, stresses the role of the gut in autoimmunity. The decline in the integrity of the gut lining, maintained by a dynamic and diverse micro-ecosystem of germs, beneficial and harmful, seems to play a significant role in autoimmunity.

This one-cell-thick gut lining is the interface where the immune system learns what is "self" versus "nonself." It also learns which germs are harmful (to fend off) versus beneficial (to keep).

When the lining of the gut is compromised — due to any combination of the above-mentioned environmental triggers — the immune system can be triggered, then overly triggered, which can increase the risk of an immune system overfiring, which is autoimmunity.

Given that genetic mutations cannot occur at a rate that explains this explosion in autoimmune diseases, we must look at the combination of environmental factors, the stress of modern lifestyles, and a decline in gut health as contributors.

Conversely, we can address these factors through healing the gut, eliminating allergens and infections, optimizing nutrients, balancing hormones, detoxification, movement and stress management. These modalities can lessen the inflammatory response and promote healing.

Tribune: Can plant-based diets help fight diseases such as rheumatoid arthritis or Crohn's disease?

Li: There is great debate about a vegetarian versus a well-sourced omnivorous diet for optimal health. The answer is most likely: it depends. It depends on age, body constitution, one's state of health, personal beliefs, access to fresh foods, cost, family/community support, among other factors.

For autoimmunity, there are specialized diets beyond plant-based versus not, like the AIP (autoimmune paleo diet), or the pegan (paleo vegan), or the ketogenic diet. Intermittent fasting has shown promise in Type 1 diabetes.

For many, these diets can create more stress and social isolation, which can worsen autoimmunity. Another risk is that longer term, many of these diets can become too restrictive, compromising the health of the gut's microecosystem or limiting certain nutrients.

The point that nutritional experts agree upon is a large variety of fresh vegetables and fruits in the diet, as seasonally aligned as possible. The rich antioxidants and phytonutrients can moderate inflammation and detoxify the body. The fibers can feed beneficial microorganisms in the gut. Key fatty acids can restore and maintain the gut lining, as well as keep the immune system in balance.

Because most people eat two to three meals a day and snacks in between, what we choose to ingest has a tremendous effect on the health of our gut and immune systems.


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