It’s Science: Autoimmune disease occurs in way more women than men. Here’s why

Autoimmune diseases like Hashimoto’s thyroiditis and rheumatoid arthritis are incredibly common. So common that you probably know someone who has one—if it’s not you. And astoundingly, nearly 80% of people with autoimmune disorders are women. 

According to the National Institutes of Health, over 23 million Americans (more than 7% of the population) suffer from an autoimmune condition, with about 25% developing more than one. Worldwide, approximately 3% to 5% of the population will develop autoimmune diseases.

Autoimmune disease (AI) occurs when your immune system is unable to differentiate between healthy tissue and potentially harmful cells so it mistakenly attacks itself, affecting one or more organs. Although how this happens is not entirely understood, environmental factors like lifestyle and diet can be triggers, as well as the gut microbiome which, when out of balance, can cause a loss of the immune system’s ability to discriminate between self and non-self. 

But being a woman is also a major risk factor.

Autoimmune disorders are increasing among women today 

Women especially are at greater risk for AI due to the simple fact they have two X chromosomes, whereas men have only one. Having two X chromosomes essentially doubles the genes present on the X chromosome, increasing the odds of a larger number of mutations that can occur. And since one X chromosome comes from your father, there is the possibility of it being viewed as a foreign substance invading your body that can elicit an immune response that causes your body to attack itself mistakenly.

Women’s AI also may be attributed to their immune systems needing to accommodate pregnancy. Even though your placenta is an organ that grows inside your uterus, it is made by your baby. Additionally, half of your baby’s DNA comes from your baby’s father. So both of these elements are “foreign” to your body. To ensure that your body does not attack the placenta or your baby, your immune system becomes suppressed in order to prevent it from rejecting your baby.  

And here’s the kicker: Because women today are having fewer children than they did a century ago, they spend far less time being pregnant. Fewer pregnancies means women’s immune systems have not been kept in check by being as suppressed as often as they had been before. An immune system that expects to be suppressed often but isn’t can be left in overdrive, looking for something to attack.

Other risk factors of autoimmune disease

Some AI diseases are due to genetics, but some are preventable. Although it takes much longer for the evolution of our bodies to catch up with our current lifestyles, there are many things we can do in the meantime to mitigate the risk of developing AI.

Reduction in these risk factors can help prevent the development of AI:

• Stress: Studies have found that up to 80% of people with AI reported persistent emotional, physical or interpersonal stress before disease onset. The release of the stress hormone cortisol can cause inflammation, which is an immune response. Too much stress can cause too much of an immune response, which can lead to AI.

• Diet: What you eat affects both the composition and function of your gut microbiome. Your gut microbiome regulates the development and function of your immune system. An imbalance in the microbiome can result from exposure to various environmental factors, including diet, toxins, drugs and pathogens—triggering both local and systemic inflammation that primes you for developing an AI.

• Environment: Your immune system evolved expecting a given load of parasites. In industrialized communities, exposure to those parasites has diminished, so the immune system has fewer foreign targets. Blame our culture’s obsession with hygiene. With this reduced load, the immune system may sometimes attack itself.

• Nutrient deficiencies: Essential vitamins and trace elements are needed for your immune system to work properly. Selenium is an essential micronutrient that plays a key role in regulating your immune system by working to help prevent inflammation damage in your body. Vitamin D has a large role in maintaining bone health but also has a role in the complex regulatory function that keeps the immune system balanced. It functions as a hormone in many ways, and a significant portion of the population is deficient in vitamin D. 

How diet can prevent autoimmunity 

Because you of course don’t have control over your genetics, your first line of defense against developing autoimmune disease or preventing another autoimmune condition is increasing your intake of nutrient-rich foods.

Autoimmune prevention starts with diet. Aim to incorporate more of the following:

• Vitamin A from sweet potatoes, carrots, dark leafy greens, fish, and liver

• B Vitamins from oysters, liver, sardines, red meat (beef), eggs and nutritional yeast

• Vitamin K2 from green leafy vegetables, grass-fed butter, and fermented foods like sauerkraut and kimchi

• Omega 3s from fatty fish like salmon and mackerel, and from plant sources like walnuts, chia, flax and hemp seeds

• Iron from red meat, wild-caught fish, beans, dark leafy greens and peas

• Magnesium from spinach, chard, pumpkin seeds, almonds, black beans, avocado and bananas

• Zinc from grass-fed beef, kefir, lamb, chickpeas, pumpkin seeds, cashews, and cocoa powder

• Vitamin D from animal and dietary fats

• Selenium from Brazil nuts, tuna, halibut, sardines, grass-fed beef, beef liver, chicken, eggs and spinach

Getting adequate nutrition and supporting your stress response through stress management and behavioral intervention are essential in helping to prevent AI, as well as getting enough sleep and exercising. Further research is needed to determine more clearly what we are doing and eating that influences the balance of our highly specialized and sensitive immune systems. We can’t help our genetics, but we can do our best to live and eat well. 

Sources:

Angum F, Khan T, Kaler J, Siddiqui L, Hussain A. The Prevalence of Autoimmune Disorders in Women: A Narrative Review. Cureus. 2020;12(5):e8094. doi:10.7759/cureus.8094

Bellan M, Andreoli L, Mele C, et al. Pathophysiological Role and Therapeutic Implications of Vitamin D in Autoimmunity: Focus on Chronic Autoimmune Diseases. Nutrients. 2020;12(3):789. doi:10.3390/nu12030789

Cojocaru M, Cojocaru IM, Silosi I. Multiple autoimmune syndrome. Maedica (Bucur). 2010;5(2):132-134.

De Luca F, Shoenfeld Y. The microbiome in autoimmune diseases. Clin Exp Immunol. 2019;195(1):74-85. doi:10.1111/cei.13158

Miller FW, Pollard KM, Parks CG, Germolec DR, Leung PS, Selmi C, Humble MC, Rose NR. Criteria for environmentally associated autoimmune diseases. J Autoimmun. 2012 Dec;39(4):253-8. doi: 10.1016/j.jaut.2012.05.001

Moyer M. Why nearly 80 percent of autoimmune sufferers are female. Scientific American, 2021 September.

Natri H, Garcia AR, Buetow KH, Trumble BC, Wilson MA. The Pregnancy Pickle: Evolved Immune Compensation Due to Pregnancy Underlies Sex Differences in Human Diseases. Trends in Genetics. 2019 July; 35  (7): 478-8.  doi.org/10.1016/j.tig.2019.04.008

Schomburg L. Selenium Deficiency Due to Diet, Pregnancy, Severe Illness, or COVID-19-A Preventable Trigger for Autoimmune Disease. Int J Mol Sci. 2021;22(16):8532. doi:10.3390/ijms22168532

Stojanovich L, Marisavljevich D. Stress as a trigger of autoimmune disease. Autoimmunity Reviews. 2008; 7(3): 209-13. doi.org/10.1016/j.autrev.2007.11.007

Vieira SM, Pagovich OE, Kriege MA. Diet, Microbiota and Autoimmune Diseases, Clinical Medicine & Surgeries. 2014; 23(6): 518-26. doi.org/10.1177/0961203313501401

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