When Your Body Turns Against You

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Lisa Hubbell suffered from bone-deep fatigue even though she slept 10 or 11 hours a day. But her son had just started kindergarten, she had recently finished a 60-mile breast cancer walk and was busy with work, so she just chalked up her exhaustion to a hectic life. But when the fatigue didn't let up and she developed joint pain a few months later, she knew something was really wrong.

In December 2002, Lisa saw a specialist who gave her a diagnosis: rheumatoid arthritis, an autoimmune disorder in which the body attacks the joints, causing them to become stiff, swollen and incredibly painful. She took steroids, which did ease the painful joint inflammation. "But they made me jittery, cranky and fat," says Lisa.

Over the next four years, Lisa tried a slew of other medicines that are known to help rheumatoid arthritis, but for her, they either worked temporarily or not at all. Then she read about an experimental new treatment, Rituxan, and the minute it was approved for rheumatoid arthritis in 2006, Lisa's doctor prescribed it to her. In just weeks, Lisa was able to get back to an almost-normal life of cooking, gardening and working as a freelance writer. "I'm a scrapper," says the 44-year-old, who lives in the Seattle area. "Rituxan gave me the ability to fight again."

Lisa is just one of an estimated 14 to 23 million Americans—three-quarters of whom are women—who suffer from autoimmune disorders, a group of 80 or more conditions (including type 1 diabetes, lupus, rheumatoid arthritis, psoriasis and multiple sclerosis) in which your immune system basically turns against you and attacks healthy organs and tissue.

But there's promising news: Thanks to a greater awareness of how widespread these disorders are—they're almost as common as cancer and heart disease—doctors now understand more about what causes them and have developed better diagnostic tools and treatments.

"It used to be that treatment of autoimmune diseases relied on one of two principles," explains Noel R. Rose, MD, PhD, director of the Center for Autoimmune Disease Research at Johns Hopkins University in Baltimore. "We either replaced the functioning of the damaged organ, as we do with the thyroid gland in thyroid disease—or suppressed the whole immune system, as we do in lupus and rheumatoid arthritis. But now we've developed drugs that target the specific parts of the immune system that are responsible for the disease."

Why the increase?

During the last few decades, the number of people with autoimmune disorders has skyrocketed. Certainly more people are being diagnosed, but that's not the only reason. Some experts believe the dramatic uptick is in part due to the increase of pollution and chemicals in the environment, which activate your immune system in much the same ways that infections do. Other researchers think that the obesity epidemic comes into play—obesity can cause inflammation, which can prompt the immune system to attack the body. Another potential culprit: being "too clean." The so-called hygiene hypothesis is based on the notion that when you're not exposed to viruses, bacteria and other germs, your immune system develops differently. When it is exposed to these things, it may respond in a way that predisposes you to an autoimmune condition, says Anne Davidson, MD, a rheumatologist at the Feinstein Institute for Medical Research in New York.

Because autoimmune diseases affect three times as many women as men, scientists suspect that the hormone estrogen may also play a role, says Betty Diamond, MD, chief of the Autoimmune Disease Center at North Shore Health System in New York. And although it's still unclear whether stress causes or simply exacerbates autoimmune disorders, research suggests that constantly elevated stress hormones can impair the immune system. In fact, numerous studies of people under chronic stress show they have much higher levels of a protein that causes inflammation.

Exposure to certain viruses like Epstein-Barr can also prompt the body to damage its own cells. "These infections can linger in our bodies long after we've recovered from the original illness and cause the immune system to mistakenly attack itself as a foreign invader," says John Harley, MD, PhD, chair of the Arthritis and Immunology Research Program at the Oklahoma Medical Research Foundation in Oklahoma City.

One thing experts do know for sure is that your genes play a role. "About one-third of your risk of developing an autoimmune disease is inherited," says Dr. Rose.

A faster diagnosis

Because symptoms of autoimmune disorders like pain and fatigue are hard to measure, and others like inflammation and weight gain or weight loss can be caused by many other diseases, getting a diagnosis can be tough. But one discovery has become a useful early warning: Certain genes and combinations of genes have been linked to these conditions. "We hope that in the next 10 years there will be a genetic test that can predict who's at higher risk for autoimmune disorders, so we can do more aggressive screening on those people and treat them before irreparable damage has been done," says Dr. Rose. (Actually experts can already do this with type 1 diabetes. "In families with a diabetic child, we can put together genetic information on the 'normal' sibling, test him or her for antibodies, and predict with a fair amount of certainty whether he or she is going to develop diabetes in the next five years," he explains.)

Doctors also now have a clearer understanding of the results of a blood screening called the antinuclear antibody test, which detects if you're making antibodies against your own cells. And even though a problem with diagnosing many (but not all) of these disorders is that there isn't one specific test to detect them, experts are much better at spotting the abnormalities that they can cause, says Josiah Wedgwood, MD, chair of the Autoimmune Disease Coordinating Committee at the National Institutes of Health.

Better treatments

All of these discoveries have led to the development of a new class of drugs called TNF (tumor necrosis factor) inhibitors, which stop the signals that cause inflammation. "TNFs are a real conceptual step forward, since they don't suppress the entire immune system and cause the health issues and side effects other medications can," says Dr. Rose.

"For many autoimmune diseases, the existing treatments we have work—like thyroid replacement hormone for thyroid disease and insulin injections for diabetes," adds Dr. Diamond. "But for the harder-to-treat disorders and people who can't tolerate steroids, these drugs give new hope. Instead of being destined for a wheelchair, patients can stay independent and even keep working. They've really transformed people's lives."

Protect your immune system

Maintain a healthy weight. Obesity can cause inflammation in the body, which can activate the immune system.

Don't smoke. Research shows that it doubles your risk of rheumatoid arthritis, and experts think it probably increases the odds of developing other autoimmune conditions.

Exercise. It strengthens your immune system and lowers levels of stress hormones. Plus, regular low-impact exercise—walking, cycling, swimming—may reduce the often-debilitating fatigue that comes with autoimmune disorders like lupus, rheumatoid arthritis and MS, according to recent studies.

Go green when cleaning. It will reduce your exposure to chemicals.

The new drugs

Humira (adalimumab) 
TREATS rheumatoid arthritis, juvenile arthritis, psoriatic arthritis, ankylosing spondylitis (a form of arthritis) and moderate to severe psoriasis. Also for Crohn's disease if other treatments don't work. 
GIVEN AS an injection, usually every other week.

Enbrel (etanercept) 
TREATS rheumatoid arthritis, moderate to severe psoriasis, psoriatic arthritis, ankylosing spondylitis, juvenile arthritis. 
GIVEN AS an injection once a week.

Remicade (infliximab) 
TREATS rheumatoid arthritis, psoriatic arthritis, ulcerative colitis, Crohn's disease, ankylosing spondylitis and severe psoriasis. 
GIVEN AS an intravenous infusion at intervals of several weeks.

Cimzia (certolizumab pegol)
TREATS moderate to severe Crohn's disease in adults who haven't been responding to conventional therapy. 
GIVEN AS injections once every four weeks.

Rituxan (rituximab)
The drugs listed above are TNF inhibitors; this drug is what's called B-cell therapy. It targets cells that play a role in rheumatoid arthritis. 
TREATS rheumatoid arthritis; also being tested for multiple sclerosis. 
GIVEN AS two infusions separated by two weeks; repeated every six months.

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Bone Health Tips for Every Decade

It may seem like osteoporosis is just a part of aging, but it doesn't have to be. While it's true you lose bone strength and mass as you get older, there are many things you can do to lower your chances of getting osteoporosis. We've spoken with experts and gotten tips for keeping your bones strong during your 20s, 30s, 40s, 50s and 60s. Though this information is arranged by decade, and some advice—like that on estrogen replacement and bone density tests—definitely applies to that age group, tips on nutrition and exercise are important no matter what your age, and should be followed throughout your life.

In Your 20s

Hip fractures and loss of bone density are likely not on the minds of most 20-somethings, but this is when women need to start working on maintaining the bone strength they have. Marjorie Luckey, MD, medical director at Saint Barnabas Osteoporosis Center in Livingston, New Jersey, says women reach their peak bone mass by their early 20s. This means you have to start working on maintaining what bone strength you have during this decade of your life. Women in their 20s should:

1. Avoid smoking. Smoking cigarettes hampers the work of bone-building cells and increases your risk of developing osteoporosis.

2. Exercise properly. Weight-bearing exercise (this can include simple activities like walking) is strongly recommended throughout your life in order to keep up bone strength. But, as with most things, moderation is key. Nathan Wei, MD, clinical director of the Arthritis and Osteoporosis Center of Maryland, says woman who have extreme exercise habits—to the point where they develop amenorrhea (loss of menstrual cycle)—trick their bodies into thinking they are going into menopause, a major risk factor for osteoporosis.

3. Watch your weight. During your 20s, you may only be concerned with keeping your figure trim, but a healthy body weight should be the goal instead. Being underweight is a high risk factor for osteoporosis. (Underweight is defined as a body mass index (BMI) of less than 18.5 kg/m2.) To find out your BMI, go to WomansDay.com/BMI.

4. Consider a vitamin D supplement. Vitamin D is important for every stage of life because it helps your body absorb calcium, which is very important for bone health. "There is an epidemic of vitamin D deficiency in the U.S.," says Dr. Luckey. "We get a lot less vitamin D than past generations because we are out in the sun less." She advises that women, especially those living in the Northeast, who don't receive as much sunlight as their Southern counterparts, take a vitamin D supplement to reach the recommended 600 to 800 IU per day. Foods such as fatty fish and milk as well as some juices contain vitamin D, but not in large enough doses to get as much as the body needs.

In Your 30s

For many women this is the decade when their focus is on building a career and starting a family. Both of these can have an effect on overall bone health. Women in their 30s should:

1. Keep salt and caffeine in check. Too much of either can promote calcium loss. Lanah J. Brenna, a registered dietician at Reactive Nutrition in Lafayette, Louisiana, advises women to limit their sodium intake to 1,300 mg a day and caffeine to 200 to 300 mg a day to help reduce bone loss.

2. Limit drinking. Excessive alcohol consumption (more than two drinks a day) has been linked to increased risk of hip and other osteoporotic fractures.

3. Consider a calcium supplement. Adult women should get about 1,000 mg of calcium a day. If you're pregnant or nursing, you should bump up your intake to 1,200 mg a day. Dr. Luckey says that most people naturally consume about 300 mg of calcium a day. Adding yogurt or lowfat cheese to your diet will help increase your numbers. "Calcium is listed on nutritional labels as a percentage; to convert that to milligrams, just add a zero," advises Dr. Luckey. If you calculate how much calcium you're getting and you still come up short, add a supplement—most contain between 200 to 600 mg.

4. Learn your family history. Find out if your mother, grandmother, aunts or sisters have (or had) osteoporosis, fractures or any other related health issues. Heredity plays a big part in assessing your risk. If you know you have a family history of osteoporosis, then you can talk to your doctor about what measures (such as earlier bone density testing) you may need to take.

In Your 40s

Hopefully you've established healthy habits during your 20s and 30s. If not, don't underestimate how important this time of your life is. Kick your fight against bone loss up a notch before you reach your high-risk 50s. Women in their 40s should:

1. Add weight training to your exercise routine. You should already be doing at least 30 minutes of physical activity a day, like walking, gardening, golfing, swimming, tennis or dancing. But now's the time to add strength training to your workout routine. Staying active throughout your life helps your bone health by increasing muscle mass, strength, balance and coordination.

2. Consider other health risks. Talk to your doctor about how other health problems such as diabetes, depression and intestinal disorders affect bone health. Also discuss how some medications as well as more intense medical treatments, like chemotherapy, can alter your body's ability to absorb calcium.

3. Figure out your fracture risk. The World Heath Organization has a tool called FRAX that helps you figure out your risk for getting a fracture over the next 10 years. Simply enter your age, height and weight, then answer a few questions about your family history and lifestyle to get recommendations for treatment.

In Your 50s

Your 50s are a time of change—the most important of which is the beginning of menopause. Dr. Luckey says that the 3 to 5 years after menopause are the most important in terms of bone density loss. "Osteoporosis can occur at any age, and for a variety of reasons," says Elizabeth Ricanati, MD, staff physician in the Department of Disease Reversal at Cleveland Clinic. However, she points out that according to the National Osteoporosis Foundation (NOF), over half of the U.S. population develops osteoporosis after the age of 50. Women in their 50s should:

1. Up your vitamin intake. The NOF recommends that adults age 50 and over get 1,200 mg of calcium daily. If you are postmenopausal and not taking hormones, the dosage increases to 1,500 mg a day. It's also recommended that adults 50 and over get more vitamin D (1,000 to 2,000 IU daily).

2. Consider estrogen replacement. Once you go though menopause, your body loses estrogen. Dr. Luckey says that women with high risk factors or signs of osteoporosis often benefit from a low-dose estrogen patch. She sometimes recommends the drug Evista, which "mimics the effect of estrogen" in the bone.

In Your 60s

The decrease of estrogen in your body during your postmenopausal years is a major cause of bone density loss. While some bone loss after menopause may be inevitable, other factors, such as breaking a bone, can put some women at higher risk than others. Women in their 60s should:

1. Get a bone density test. According to Dr. Luckey, all women over 65 should get routine bone density tests. If you're under 65, postmenopausal and have high risk factors, such as a family history of osteoporosis or a broken bone after age 40, it's also recommended that you have regular bone density tests.

2. Protect yourself against falls. Wear shoes with nonslip soles, clear things from the floors that could be easily tripped over, keep hallways and corners well lit, use a stepstool with handrails and be careful with medications that affect your balance or make you drowsy.

3. Talk to your doctor about prescription medication. Depending on how advanced your bone loss is, your doctor may suggest you take medication to prevent further bone loss. Dr. Ricanati explains, "There are different classes of medications to treat osteoporosis, such as the bisphosphonates (Fosamax, Boniva, Actonel and Reclast), SERMs (selective estrogen receptor modulators), estrogen/progestin, parathyroid hormone and others." Dr. Wei also points to a new treatment, denosumab, which is recommended for women who experience side effects from bisphosphonates. As with any prescription drug treatment, there are risks associated with most medications, and the best avenue is always prevention.

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10 Perfect Foods

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• 10 Perfect Foods

  If you were stuck on a deserted island, what foods would you want with you? At first you might think about your favorite snacks, but ultimately you'd need nutrient-packed foods to keep you healthy for the long haul. To figure out what would make the cut, we analyzed dozens of foods. We awarded points for the amount of key nutrients that each one contains and crossed off any that have trans fats or high amounts of saturated fat or sodium. The result: 10 "perfect" foods.

  Photo: © Comstock

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  • Almonds

    The combination of protein and fiber (3 grams an ounce) in this tasty nut will keep you feeling full. A good source of healthy monounsaturated fats, almonds also contain calcium and vitamin E. Studies have shown that eating them may help keep your bones strong and perhaps even lower your cholesterol.

    Try this:
    Sprinkle pan-toasted, sliced or slivered almonds onto nearly any cooked veggie, like broccoli, kale or green beans.

    Photo: © Comstock

    
    

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  • Avocados

    The fat in avocados may be high, but it's mostly the heart-healthy monounsaturated kind. They're also a great source of vitamin C, potassium, folate and lutein, which is beneficial for eye health. Avocados contain a plant sterol (beta-sitosterol) that may help lower cholesterol levels.

    Try this:
    Mash avocado and stir until smooth, add a squirt of lemon or lime juice, and use in place of mayo or other condiments.

    Photo: © Comstock

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    • Eggs

      For just 75 calories, one little egg gives you 13 essential vitamins and minerals, including choline (which may help prevent birth defects), selenium (an antioxidant) and riboflavin (which helps you produce red blood cells and releases energy from carbs). Don't skip the yolk; it contains the bulk of the egg' nutrients, including vision-protecting lutein and zeaxanthin. Because they'e a good source of high-quality protein, eggs may also help you feel full longer.

      Try this:
      Serve a pan-cooked egg on top of a pizza slice, like they do in Italy.

      Photo: © Comstock

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      • Kale

        Though this leafy green looks a little like spinach, it's actually more closely related to cabbage, and provides more nutritional value per calorie than nearly any other food. It's rich in vitamin K (important for bone health and normal blood clotting) and beta-carotene (which protects your sight). It also contains compounds that may reduce your risk of ovarian, breast and other types of cancers.

        Try this:
        Finely chop it and use it in place of spinach in cooked dishes, such as lasagna.

        Photo: © Comstock

        
        

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      • Quinoa

        It's now super-trendy, but this grain has actually been around for thousands of years. It's different from almost every other plant food on the planet because it's a complete protein, which means it contains all of the essential amino acids that your body needs. What's more, quinoa has a significant amount of iron, potassium and magnesium. The tiny grains look similar to sesame seeds and have a nutty flavor and fluffy, crunchy texture—and they cook in less than 15 minutes!

        Try this:
        Eat quinoa at any meal that would normally include rice (like Japanese or Chinese food). Drizzle a little teriyaki or soy sauce onto it for extra flavor.

        Photo: © Comstock

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        • Raspberries

          They're loaded with potassium, vitamin C, fiber and protective antioxidants like anthocyanins, salicylic acid, quercetin and catechins. They're also especially rich in a compound called ellagic acid, which research suggests may play an important role in cancer prevention.

          Try this:
          Create a sandwich spread by mixing Dijon mustard with mashed raspberries.

          Photo: © Comstock

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          • Sweet Potatoes

            One sweet potato has all the beta-carotene you need in a day—a nutrient that research indicates may be cancer-protective. Your heart will be happy, too, thanks to the vitamin C and potassium content. Be sure to eat the peel—it contains fiber along with additional disease-fighting phytonutrients.

            Try this:
            Dice boiled, chilled sweet potato and stir into your favorite guacamole recipe. For a unique taste twist, slice boiled sweet potato and use instead of tomato as a topping on your turkey or veggie burger. l Mash up baked sweet potato with a little vegetable broth and serve as an eye-appealing "bed" for an entrée, like salmon.

            Photo: © Comstock

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            • Teff

              You've probably never heard of it, but it's definitely worth trying. These tiny whole grains are super-nutritious: Teff has more than twice as much iron and about 20 times as much calcium as other grains, plus a significant amount of fiber. But it's the unique molasses-like flavor that will really win you over.

              Try this:
              Pour 1/4 cup boiling water over 1/2 cup dry (uncooked) teff. Let sit for about 10 minutes, then mix into extra-lean ground beef or turkey for a healthier, moist and tasty burger.

              Photo: © Comstock

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