Autoimmune Remission Is Possible

3 words. I wish someone had said them to me the day my diagnosis arrived, and I want you to hear them now, before anything else in this chapter.

Remission is possible.

For the Other Versions of My Mother

I learned the stakes of this work first from my Mother.

She lived with colitis and Crohn's, both Autoimmune conditions, and the word Autoimmune was never spoken in our home. I sometimes wonder whether she was ever told they were Autoimmune at all, or whether she simply carried the labels.

Most of my growing up, from about 5 to 18, coincided with her Perimenopause and Menopause. It was a very difficult passage, and no one was tracking it, naming it, or treating it.

No one checked her sex hormones. No one checked her thyroid. No one checked her ferritin.

She was, by the standards of her era, a Woman with resources. The care that could have asked those questions did not exist yet, for her or for so many Women of her generation.

She was amazing, luminous, larger than life, and she showed up for other people in a way people still remember. She could also be moody, and at times so intense it took the air out of a room, especially at home. I understand now that I was watching a brilliant Woman navigate an unsupported body with no map.

At 58, she developed a fast-moving glioblastoma, a brain tumor. I was 22.

I cannot say her Autoimmune conditions caused her brain tumor, and I do not claim that they did.

What the research does show is that Autoimmune conditions carry a well-documented, elevated risk of additional illness, including some cancers, and polyautoimmunity means carrying more than 1 of those risks at once. The American Cancer Society lists ulcerative colitis and Crohn's disease as raising the risk of colorectal cancer, because years of inflammation in the colon can change its cells. A 2005 analysis also found higher rates of non-Hodgkin lymphoma in Sjögren's, lupus, and rheumatoid arthritis.

That research does not reach a glioblastoma, and I leave it exactly where the evidence leaves it.

What I know is simpler. A body that only ever manages an Autoimmune condition, and never tends what drives it, is a very compromised system carrying an unnecessary load. The questions nobody asked her, the labs nobody ran, the support she never had, are the things I have built my life around giving to other Women.

This chapter is for the other versions of my Mother.

She is the Woman taking her thyroid pill every morning, believing it is treating her Hashimoto's. She is the Woman told at diagnosis that her future is a life of managing flares. She is the Woman with 2 diagnoses and a third 1 quietly building, who has never once heard the word Remission applied to her.

If any part of that is you, this chapter is yours. I tell more of my Mother's story, and my own, in 'My Story, Why I Do This Work, and How to Work With Me'.

What Remission Means

Remission was a word I associated with cancer. It took educators to tell me that Remission was a word that belonged to me too.

As 'How Autoimmunity Begins: The 3 Factors and the Years Before a Diagnosis' defines it, Remission means the Autoimmune expression is calm. The susceptibility is still written in you, and the immune system has stopped its active assault on your tissue, the inflammation has come down, and your symptoms are absent or minimal.

Remission is your immune system finding its proper aim again. The devoted protector is still on duty, and it has stopped aiming its care at your own tissue.

Remission shows up in 2 places at once: in your labs, and in your life.

In your labs, it shows up as antibodies that have quieted. For Hashimoto's, the Remission targets I work from are TPO antibodies under 9 IU/mL and thyroglobulin antibodies (TgAb) under 1 IU/mL. These are my practice convention, and the TPO target sits far below Labcorp's conventional flag of 34 IU/mL.

'Your 2 Antibodies: What the Numbers Can Tell You', in the Thyroid chapter, walks through how to read every number on the way down.

Different Autoimmune conditions track different markers, and the principle holds for all of them. You are watching a trend, in a direction, over time.

In your life, it shows up as the fog lifting, the joints easing, and energy that lasts through the afternoon instead of collapsing at 3.

You wake rested. You think clearly. You stop organizing your whole day around what your body can afford.

I know that kind of organizing from the inside. For years, Christopher and I had a nap blocked into both of our calendars, every single day, 4:30 to 6.

I could not quit working full time, so I needed the rest, and we arranged our work schedule around my energy. If I had never learned what I teach in this book, that calendar entry would still be there.

The 2 do not always move together. Symptoms often ease months before antibodies budge, and a Woman with high antibodies can feel relatively well, which is why I track both.

My own TPO antibodies started in the 350s. I watched them come down, through the 200s, the 100s, the 80s, the 60s, and into the 50s, and I felt different at every marker along the way.

What Remission Does Not Mean

Remission and cure are 2 different words, and the difference is good news.

A cure would mean the condition is gone, with nothing to maintain and no chance of return. Current research has not achieved that for any Autoimmune condition. Remission is the real, reachable horizon, and many Women reach it and hold it.

Here is what Remission does not promise:

• A life without care. The susceptibility stays with you. Remission is something you tend, the way you tend a garden that is finally thriving.
• A body that never flares again. Significant stress, a hidden gluten exposure, a hormonal shift, an infection, a course of antibiotics, surgery, a loss, or a move can each pull you back toward activity.
• The end of your medication. A thyroid that lost tissue before the Autoimmune process calmed may still need hormone replacement. Every medication decision stays with your prescriber.
• Perfection. The work is not linear, and it was never meant to be.

A flare is information. It tells you a condition changed. When 1 comes, you return to your Remission baseline, the specific combination of food, sleep, movement, calm, and relationships that you have learned keeps you well.

The path back tends to get shorter each time, because you are following a map you drew yourself.

Once you know your own body, you are never starting from zero again. You are returning to a place you already know how to find.

When 1 Becomes More Than 1

There is a word for having more than 1 Autoimmune condition: polyautoimmunity. 'How Autoimmunity Begins: The 3 Factors and the Years Before a Diagnosis' introduced it, and it is the quiet cost of the first path.

The numbers vary with how researchers count, and they point the same way. A 2010 review put it at about 25 percent of people with 1 Autoimmune condition developing at least 1 more. In the study of more than 1,000 people described in 'How Autoimmunity Begins: The 3 Factors and the Years Before a Diagnosis', about a third already had more than 1.

Getting a diagnosis, and even treating the downstream symptom with medication, leaves the terrain underneath unchanged.

The genes stay the same. The gut barrier often stays open. The triggers, if no one addresses them, keep arriving.

So the same conditions that let the immune system misread 1 tissue remain in place to let it misread another. The label is new, and the terrain is the same.

This is how Autoimmunity builds on itself when it goes untended:

• Inflammation stays switched on. The inflammation of the first condition keeps loosening the seams of a gut lining that is 1 cell thick, as 'The Pathway to Autoimmunity: The Chain, Link by Link', in 'How Autoimmunity Begins: The 3 Factors and the Years Before a Diagnosis', describes.
• More fragments reach the immune system. Through an open barrier, more food proteins, bacterial fragments, and toxins arrive, and each is 1 more chance for molecular mimicry to aim the immune system at a new tissue.
• The load climbs. Poor sleep, pain, fatigue, and worry are triggers in their own right, and a first condition tends to bring all 4.
• The file thickens. Hashimoto's, then IBS, then fibromyalgia, then joint pain no one can explain. Dr. Datis Kharrazian describes that thick file as the clinical presentation of undiagnosed Autoimmunity, and 'The Thick File', in the Thyroid chapter, shows you how to look for it.

You may hear it said that an untended Autoimmune condition is joined by another every several years. I would not hold you to a specific number, because the pace varies enormously from person to person. The direction is what is well established: untended, the risk of a second and a third condition rises.

The hopeful side is the same fact read the other way. Because these conditions share roots, every piece of work that calms the gut, steadies the Nervous System, and lightens the triggering load tends the whole soil, including the plants that have not surfaced yet.

2 Paths, and Your Choice Between Them

At diagnosis, 2 paths open in front of every Woman, and most are only ever shown 1 of them. 'How Autoimmunity Begins: The 3 Factors and the Years Before a Diagnosis' names them: 'Non-Action' and 'Toward Remission'.

'Non-Action' is the path of a little action. You take the medication for the downstream symptom, you get skillful at managing your flares, and you learn to live with it. For many Women, this is where the story stops, because no one tells them there is another option.

On a day-to-day level, 'Non-Action' can look like this:

• A thyroid pill every morning, and a TSH once a year.
• Antibodies that were measured once, at diagnosis, and never again.
• Ibuprofen for the joints, coffee for the fatigue, and a quiet belief that this is simply aging.
• A second diagnosis that arrives as a surprise.

'Toward Remission' is the path of working consciously on the conditions that let the Autoimmunity take hold, the gut barrier and the triggers. The Autoimmune Recovery Method is my map for that second path.

Both paths are real choices, and you have the final say. In my classes, right after I say Remission is possible, I ask 2 questions, each on a scale of 0 to 10.

How badly do you want it? And then, how willing are you to do whatever is asked of you, whatever's on the map? There's no right or wrong.

There are some people who would say, I'm not giving up dairy. I want dairy more than I want my numbers to be in Remission, and I don't mind managing flares.

It's your life. You get to choose.

Awareness affords choice. If your willingness sits at a 6 today, that honest 6 is a far better place to begin than a 10 you do not mean.

Wanting is a number that can shift across a day. Some moments you may be very present to your 10, and some mornings you may limp in at a 6. The practice is to find your way back to your 10, honestly, again and again.

So I invite you to refresh your why every morning, and again whenever a day turns hard. Your why is the engine of this work, the main meal on the plate, and every protocol in this book runs on it.

There are 2 kinds of acceptance here, and both are true at once. The first accepts what is real: I have Hashimoto's, or I have rheumatoid arthritis, and denial keeps me stuck. The second, and the more powerful, accepts your condition as something your body can shift.

It is real, and it is workable. The second acceptance is the 1 I put my gaze on every day.

The Autoimmune Recovery Method: 6 Keys Around 1 Center

Almost everything in this method I had already been teaching for decades, long before I had a name for my own condition. For years I taught a body of work I called the Awareness Keys, in yoga teacher trainings, group courses, and 1:1 mentorship: community, relationships, calm, the shape of a day, and Aliveness.

There was 1 Key I had not yet been teaching: the gut and the nourishment of an Autoimmune body. That is the piece my own diagnosis added, and I had to learn it the hard way. When I brought the Autoimmune Protocol together with everything I had already taught, the Autoimmune Recovery Method was born.

I call them Keys of Action on purpose. The first path is 'Non-Action', and each of these 6 is a real place where you take action on the terrain your condition grows in.

• Key 1, Community & Foundations
• Key 2, Gut & Nourishment
• Key 3, Environment & Rhythms
• Key 4, Love & Healthy Relationships
• Key 5, Calm & Resilience
• Key 6, Purpose & Aliveness

Technically, there are 12 Keys. I paired them into 6 to make the map less overwhelming, so each Key has 2 halves.

Think of the 6 Keys as 6 doors into the same house. There is no rigid order to walk them in, and over time you tend all of them.

A few rules hold the whole map together:

• No Key outranks another. That does not mean each asks the same of you at the same time.
• None of the 6 is optional. You cannot swap 2 strong Keys in for a weak 1 and call it even.
• There is no neutral gear. Every day, in 100 small ways, each Key is moving you toward Remission or away from it, like a dimmer switch turning 1 way or the other.
• All 6 rotate around 1 center. The center is a skillful, qualified medical practitioner, and it is the container all 6 Keys need.

A Woman who eats a flawless elimination diet while staying in a chronically stressful relationship is still standing in her own way. A Woman who transforms her relationships and calms her Nervous System, and never addresses her gut, is doing half the work. Remission asks for all 6, moving and weaving together.

For many of the Women I work with, the practitioner at the center has not turned out to be their primary care doctor, their endocrinologist, or their rheumatologist, who each do vital work within their own training. More often it is a Functional Medicine practitioner who understands Autoimmunity. A simple test: if your practitioner sat in on this chapter, would they nod along?

Christopher and I share a small joke about this map. We built it as the map for getting out, and it turns out to be the map for not getting in. If you are in your 20's, 30's, or 40's and no condition has taken hold, these same 6 Keys are quiet prevention.