Why 80% of Autoimmune Diseases Happen to Women & Solutions From a Renowned MD

KEYPOINTS

• 01

  Autoimmune disease is a case of mistaken identity.

  Dr. Sara Szal, a Harvard- and MIT-trained physician who directs precision medicine at the Marcus Institute of Integrative Health at Jefferson, compares the immune system to private security. It's meant to recognise your own tissue and attack invaders. When it gets confused, it makes autoantibodies against normal tissue, which she calls a 'civil war' in the body. She describes health and autoimmune disease as two ends of a spectrum. In the broad middle, antibodies and early symptoms can be present years before anyone diagnoses a disease.

• 02

  There are more than 100 autoimmune diseases, and many people don't know theirs is one.

  Classic examples include rheumatoid arthritis, type 1 diabetes, Hashimoto's thyroiditis, Graves' disease, celiac disease, multiple sclerosis and psoriasis. Szal adds conditions that share features with autoimmunity, such as endometriosis, some forms of IBS, chronic Lyme disease and long COVID. She says people often go 7 to 14 years before getting a diagnosis.

• 03

  Rising antibody rates point to environment, not genes.

  Szal says about 30% of Americans have anti-nuclear antibodies, and that positive results have nearly tripled over 25 years. Because genetics haven't changed that fast, she attributes the rise to changes in food, stress and trauma levels.

• 04

  Three requirements: genes, a leaky gut and a trigger.

  Citing a pediatric gastroenterologist at Massachusetts General Hospital, Szal lists three root causes: genetic predisposition, increased intestinal permeability ('leaky gut') and a trigger. You can't change your genes yet, but she says you can work on the other two.

• 05

  A leaky gut is a lost boundary.

  The gut lining relies on 'tight junctions' between cells. When they fail, bacteria, viruses and foods such as gluten or dairy can slip through. Since 70 to 80% of the immune system sits along the gut, this sets off the immune system in ways it isn't meant to be. Alcohol is the worst offender for tight junctions; Szal notes it's the standard way to create leaky gut in lab animals. Too much stress also contributes, through corticotropin-releasing hormone, and so do very hard training and night shifts, which she links to more autoimmunity because they disrupt the body clock.

• 06

  Trauma is the most common trigger she sees, followed by hormones.

  Szal says she wasn't taught about trauma in medical school but kept seeing autoimmunity in patients with traumatic births or high Adverse Childhood Experiences (ACE) scores. Hormonal shifts matter too. Pregnancy forces the immune system to accept an embryo that is half someone else's DNA, which usually works but can lead to miscarriage or postpartum autoimmune problems. The most common spike she sees is during perimenopause and menopause, roughly ages 40 to 55.

• 07

  Women are about four times more likely than men to have autoimmune disease.

  Szal says X-versus-Y chromosome biology is necessary but not sufficient to explain the gap. She points to socially constructed gender differences: women experience more stress and trauma, experience trauma earlier, and develop PTSD at higher rates after the same trauma. They also carry more of the caregiving burden. She lists research gaps and a treatment gap, citing a figure that 73% of women seeking help for perimenopause or menopause don't get the treatment they need. Her conclusion: 'it's a health hazard to be female in our culture.'

• 08

  Childhood adversity affects the body through the PINE network.

  PINE stands for psychology, immune, nervous and endocrine systems. Szal says adversity in childhood dysregulates this network. Depending on the person, that can mean immune confusion and autoimmunity, lifelong cortisol problems, or a nervous system stuck on high alert with low heart rate variability. She adds that understanding your trauma intellectually doesn't stop it living on in the body.

• 09

  Lifestyle medicine adds to standard treatment rather than replacing it.

  Szal argues that sleep, food, movement, emotions and relationships account for about 80% of the prevention and reversal of chronic disease. Medicine often treats symptoms instead, for example a steroid cream for psoriasis without asking about the gut. She is clear that some conditions are too advanced for lifestyle changes alone, such as type 1 diabetes once the insulin-producing cells are gone. Someone with rheumatoid arthritis on methotrexate could add an elimination diet, which she says has randomized-trial support for RA, and possibly lower the dose, but only with a clinician involved.