031 The Case of Confusing Lupus Diagnosis w/ Dr. Tiffany Caplan

The Case: 

• Miranda is 42
• She was experiencing rashes on her face and chest, joint pain, and fatigue.
• A dermatologist prescribed antihistamines and a Physical therapist gave her exercises for the joint pain. 
• There was no explanation or treatment for the fatigue.

Miranda’s doctor responded to her condition the way many do - by ruling out the obvious (in this case, arthritis) and then treating the symptoms. More blood tests revealed the presence of ANA or anti nuclear antibody. This indicated that it could be Lupus but it could also not be Lupus. After months of waiting to see her rheumatologist the Lupus diagnosis was confirmed. But, her health mystery still hadn’t been solved because the root cause was still unknown.

 

The Investigation

An estimated 5 million people worldwide have Lupus, and about 1.5 million of them are in the United States. Dr. Tiffany Caplan is a chiropractic physician and a Certified Functional Medicine Practitioner who specializes in treating Lupus patients. She, along with her husband Dr. Brent Caplan founded the Central Coast Center for Integrative Health in Ventura California and wrote the book “The Lupus Solution”.

On this episode of Health Mysteries Solved, Dr. Tiffany shares her knowledge in relation to Miranda’s case. 

 

What is Lupus?

Lupus is an autoimmune disease that affects an estimated 5 million people around the world, although Dr. Tiffany feels this is an underestimation because the disease is very difficult to diagnose.  Lupus is more likely to affect women (90 percent of all Lupus patients are female) and it is usually diagnosed during their childbearing years. Because Lupus is so hard to diagnose, it can be years of dealing with symptoms before a patient gets a diagnosis.

 

Common Symptoms of Lupus

The most common (and telltale) symptom is a butterfly-shaped rash on the face. While not all patients present with this rash, when someone does have it, it is a good indication of Lupus. Other symptoms may include fatigue, pain (joint-pain, body-aches, general achiness), stomach pain and/or nausea, headaches, photo-sensitvity, mouth ulcers, and/or acne. Lupus can sometimes occur in conjunction with other autoimmune diseases like Hashimoto’s, Sjorgren’s, or Raynaud’s disease, which means that symptoms associated with these diseases can also be symptoms of Lupus. 

 

The Difficulty of Diagnosing Lupus

Lupus is a systemic autoimmune disease so it can attack different parts of the body, in different ways, at different times which makes it hard to connect the dots. There are 11 different criteria that are considered in diagnosing Lupus but not all of these need to be satisfied for it to be Lupus. Other diagnoses (like Hashimoto’s or kidney disease) might come first and end the search for the real cause as symptoms are lumped into that single diagnosis. Typically, it takes about seven years for someone to be diagnosed with Lupus. 

 

How Lupus is Diagnosed

In addition to considering the clinical criteria (symptoms), there are a variety of lab tests that can help confirm a Lupus diagnosis. A DNA test could reveal an anti-double-stranded DNA marker which is present in about 80% of Lupus patients. A positive test for anti-Smith antibody and various antiphospholipid antibodies that are present in about 30% of lupus patients that can also be indicators. Doctors may also test the function of the immune system function by looking at complement c3 and complement c4 levels through blood tests.

 

Treating Lupus Traditionally

Most conventional doctors will deal with Lupus by prescribing immunosuppressants (since the immune system is overactive). They may also prescribe medication to treat the other symptoms such as antidepressants, pain medication, and/or sleep medication. However, a functional medicine approach to treating lupus doesn’t focus on treating the symptoms but rather getting to the root cause. 

 

The Root Cause of Lupus

Each patient is going to be different, but the most common root causes of Lupus flare-ups involve gut issues (80% of your immune system lives in your gut), exposure to toxins or chemicals, and nutrient deficiencies (especially vitamin D, Omega 3s and Glutathione. Additionally, hormone imbalances, adrenal fatigue, and emotional or mental health issues can also be triggers for Lupus.

 

Holistic Approach to Treating Lupus

The first move Dr. Tiffany makes when working with a Lupus patient is to put them on an elimination diet. This will help identify the role various foods might be playing in Lupus symptoms - especially inflammation. Some doctors also recommend cutting out alfalfa sprouts, bean sprouts and even garlic as these can cause issues for Lupus patients. 

Repairing a leaky gut and/or resetting the gut microbiome can be essential in treating Lupus holistically. Test for parasites or enzyme deficiencies will also help fill in the picture of what’s going on. Further test on cortisol levels will help determine if stress is a potential factor. 

 

Vitamin D Deficiency

Dr. Tiffany says that most people are deficient in vitamin D and it’s really important to correct that. Even if tests show that you are in the ‘normal range’ (which is very wide). In the US, the range is usually about 30 to 100 which means that you could be at 31 and be considered in the norm. But,that is very low and ideally, especially for someone who has autoimmunity, those readings should be more towards 50, 60 even 70. 

 

Hope for People with Lupus

Dr. Tiffany is passionate about helping patients with Lupus who have been told that they should get used to living with symptoms and expect to take medications for the rest of their lives. She’s seen diet and lifestyle changes result in patients getting off those drugs and feeling much better. Lupus does not have to mean a lifetime of pain and chronically feeling unwell.

And, remember to listen to your body - trust your gut. If you suspect there is something bigger going on beyond the symptoms, advocate for your own health and demand to have your health mystery solved. 

 

Mystery Solved

Miranda’s Lupus diagnosis left her feeling hopeless and helpless. But, we spent some time finding the root cause of the issues. We started by cleaning up her diet. Food sensitivity tests revealed that she had issues with corn and dairy. We also removed sugar and gluten from her diet. These dietary shifts made a huge difference - her rash got dramatically better and she was thinking clearer again.

But, we weren’t done yet. Further testing showed that she was dealing with an active Epstein Barr Virus so we got her on an antiviral protocol which included Lysine, NAC, Selenium and Zinc along with Monolaurin Avail. After 5 weeks on the protocol she started to get her energy back.

Test revealed that her immune system was functioning ...