Why 80% of Autoimmune Diseases Happen to Women & Solutions From a Renowned MD
Here are the top 10 key takeaways from Dr. Sarah Szal's discussion on autoimmune diseases in women, offering valuable insights that could transform your understanding of these conditions and potential paths to healing.
1. Autoimmune diseases affect women four times more than men
Autoimmune diseases disproportionately impact women, with a 4:1 ratio compared to men. This disparity stems from both biological sex differences (X vs. Y chromosomes) and socially constructed gender differences. Dr. Szal emphasizes that the gender gap isn't simply biological but reflects social factors that impact women's health.
Women experience more stress, trauma, and hormonal fluctuations throughout life. They undergo significant hormonal changes during pregnancy, postpartum, perimenopause, and menopause, which can trigger autoimmune responses. Women are also more likely to experience trauma earlier in life and develop PTSD when exposed to the same traumatic events as men.
2. Understanding what autoimmune disease is
Autoimmune disease occurs when the immune system becomes imbalanced and attacks normal tissues in the body. Dr. Szal describes it as a "case of mistaken identity" where the body's security system (immune system) becomes confused and can't differentiate between healthy tissues and invaders like viruses. This confusion leads to the production of autoantibodies against normal tissues.
There are over 100 different autoimmune diseases, including rheumatoid arthritis, Hashimoto's thyroiditis, multiple sclerosis, type 1 diabetes, and psoriasis. Many people don't recognize common conditions like psoriasis as autoimmune diseases. The prevalence of autoimmune markers has nearly tripled over the past 25 years, suggesting environmental rather than genetic causes for the increase.
3. Three root causes of autoimmune conditions
Dr. Szal identifies three fundamental causes of autoimmune conditions. First is genetic predisposition, which can be identified through genetic testing. Second is leaky gut, described as a loss of boundary in the digestive tract where tight junctions between cells become compromised. Third are triggers like trauma, stress, or hormonal changes that initiate the autoimmune response.
While genetics cannot be changed, both leaky gut and triggers can be addressed to manage or reverse autoimmune conditions. This approach focuses on root causes rather than just treating symptoms. Understanding these three components helps explain why autoimmune conditions develop and provides a framework for addressing them effectively.
4. Leaky gut as a crucial factor
Leaky gut, described poetically as "a loss of boundary in your body," plays a central role in autoimmune diseases. Normally, the intestinal lining has tight junctions between cells that prevent foreign particles from entering the bloodstream. When these junctions fail, bacteria, viruses, and food particles can pass through and trigger immune responses.
With 70-80% of the immune system located in the gut, these breaches can cause significant immune dysregulation. Alcohol is particularly damaging to these tight junctions, which is why it's used in animal studies to induce leaky gut. Other factors like chronic stress can also compromise gut integrity through the release of corticotropin-releasing hormone (CRH), which directly damages the intestinal barrier.
5. Trauma and stress as major triggers
Trauma, particularly from adverse childhood experiences (ACEs), is a primary trigger for autoimmune conditions. Dr. Szal explains that traumatic experiences change the stress response in the body and disrupt what she calls the "PINE network" – Psychology, Immune system, Neurological system, and Endocrine system. For some individuals, the immune system becomes most dysregulated, increasing autoimmunity risk.
Even when people believe they've cognitively processed past trauma, the physical effects often persist in the body. According to research, each elevated ACE score (one or higher) increases autoimmunity risk by approximately 20%. This explains why addressing stored trauma is crucial for healing autoimmune conditions, even years after the traumatic events occurred.
6. Common symptoms that may indicate autoimmune issues
Autoimmune diseases present with various symptoms that doctors often label as "non-specific." Common indicators include fatigue, exhaustion, inflammation, swelling, and joint pain. Specific autoimmune conditions produce additional symptoms based on which tissues are being attacked. For example, Hashimoto's thyroiditis may cause unexplained weight gain, difficulty "putting your foot on the gas," and intolerance to cold.
Other potential symptoms include intermittent low-grade fevers, night sweats, neuropathy (tingling in limbs), digestive issues, skin reactions, swollen glands, anxiety, depression, and visual changes. Dr. Szal recommends seeking medical advice if you experience three or more of these symptoms, and consulting specialists if symptoms persist or worsen.
7. The rise of autoimmunity and diagnostic delays
Autoimmune conditions are significantly increasing, with anti-nuclear antibodies nearly tripling over the past 25 years. Despite this rise, many medical schools don't adequately address autoimmunity, resulting in patients struggling for 7-14 years before receiving proper diagnoses. This diagnostic delay occurs partly because medical training often focuses on pharmaceutical interventions rather than identifying and addressing root causes.
Dr. Szal suggests this approach is influenced by the pharmaceutical industry's focus on blocking biochemical pathways rather than working with the body's natural intelligence. Lifestyle medicine, which Dr. Szal had to teach herself after her own medical training, offers a more comprehensive approach to addressing autoimmune conditions by targeting their underlying causes.
8. Perimenopause and menopause as peak periods for autoimmune conditions
The most common spike in autoimmune symptoms and diagnoses occurs between ages 40-55, coinciding with perimenopause and menopause. During this time, women experience not only hormonal changes but also often face increased caregiving responsibilities for both children and aging parents, potential relationship changes, and career stresses. This convergence of internal and external factors creates significant immune system challenges.
Dr. Szal explains that the menopausal transition involves more than just declining estrogen and progesterone levels. It encompasses complex changes in immune function, metabolism, and cellular energy production. The body experiences confusion as established patterns change, which can trigger or exacerbate autoimmune responses during this vulnerable period.
9. Testing and practical steps for managing autoimmune issues
Dr. Szal recommends comprehensive testing to evaluate immune function, inflammation, metabolism, and hormones. Specific tests include complete blood count with differential, high-sensitivity C-reactive protein, erythrocyte sedimentation rate, neutrophil-to-lymphocyte ratio, glucose and insulin levels, and hormone panels including estrogen, progesterone, testosterone, and vitamin D.
For those without access to testing, an elimination diet provides a free, accessible approach to identifying triggers and reducing inflammation. Removing gluten, dairy, alcohol, and sugar for three weeks can help determine if these common irritants are contributing to symptoms. This approach helps establish whether dietary changes improve symptoms and provides a starting point for healing.
10. Empowerment through lifestyle medicine
Lifestyle medicine offers a powerful approach to managing and potentially reversing autoimmune conditions by addressing root causes rather than just treating symptoms. Unlike pharmaceuticals that block biochemical pathways, lifestyle changes work with the body's natural intelligence to restore balance. The approach focuses on regulating the body through proper nutrition, stress management, and addressing underlying trauma.
Dr. Szal emphasizes that living in a regulated state is ultimately easier than enduring the discomfort of dysregulation. Making conscious choices about diet, stress management, and healing past trauma sends positive cues throughout the body's systems. This approach returns agency to individuals who may have felt dismissed or disempowered by conventional medical approaches that failed to address their chronic conditions effectively.