Why Are So Many Women Getting Autoimmune Diseases? (Autoimmunity Series: Part 1)

Women are 3.5 times more likely than men to get autoimmune disease…but why? Learn which autoimmune conditions are most common in women and five possible reasons for the gender bias, based on the scientific research. 

Note from Dena: This post was co- written with Sarah Kaufman, Dietetic Intern, as part of a research partnership between Back To The Book Nutrition and post-graduate nutrition students from the University of Houston.  

Autoimmunity is on the rise in the Western world. Approximately 50 million Americans having at least one autoimmune disease – 78% of those are women. In fact, autoimmunity is one of the top 10 causes of death in U.S. women under the age of 65. (1-3)

What is an Autoimmune Disease?

Autoimmunity is an inflammatory state in which a person’s immune system produces antibodies that attack its own tissue. This response is either organ specific or systemic (non-organ specific).

Organ-Specific Autoimmune Diseases are those in which an immune response is directed toward a single organ. Examples include celiac disease (gluten consumption triggers an attack on the small intestine), pernicious anemia (an attack on parietal cells in the stomach, leading to B-12 deficiency), and autoimmune thyroid disorders like Hashimoto’s thyroiditis and Graves disease (which both attack thyroid tissue).

In Systemic Autoimmune Diseases, the immune system attacks multiple areas of the body. Examples include rheumatoid arthritis, lupus, and multiple sclerosis.

MOST COMMON AUTOIMMUNE DISEASES IN WOMEN

1. Rheumatoid arthritis – The immune system attacks the lining of the joints leading to inflammation that can affect the entire body

2. Psoriasis – The immune system becomes hyperactive and signals excess skin cell production that results in a build up of tissue.

3. Psoriatic arthritis – An immune response in those with psoriasis that causes inflammation, joint pain, stiffness and swelling affecting the entire body.

4. Lupus – The immune system causes inflammation, swelling, damage to joints, skin, kidneys, blood, the heart, and lungs. Heart disease is a major complication of lupus and is now a leading cause of death among people with the disease.

5. Thyroid diseases (Grave’s disease, Hashimoto’s thyroiditis) – Antibodies attack thyroid tissue, resulting in altered levels of thyroid hormone – high levels (hyperthyroidism) in Grave’s and low levels (hypothyroidism) in Hashimoto’s, which affect every cell in the body.

WHAT CAUSES AUTOIMMUNE DISEASES? 

While each autoimmune condition is distinct in certain ways, renown autoimmune expert Dr. Alessio Fasano explains that all autoimmune diseases require these three factors: (7-9) 

1. Genetic predisposition – autoimmune disease seems to run in families
2. Environmental triggers – stress, poor diet, nutrient deficiencies, food additives, gut infections and overgrowths, medications, etc. 
3. Leaky gut – damage to the intestinal lining allows food proteins, bacteria, and other substances to “leak” back into circulation, triggering immune responses that can eventually lead to autoimmunity

So, back to the big question – why women? 

Why Are So Many Women Getting Autoimmune Diseases?

The exact reason women are 3.5 times more likely to develop autoimmune diseases than men still isn’t fully understood, but there are several theories about contributing factors.

1. Female vs. male immunity

Women have enhanced immune reactions compared to men, which provide superior protection against infection, but may also contribute to the onset of autoimmunity. (4)

2. Sex hormones

The female hormones estrogen and prolactin have been shown to enhance autoimmune responses, worsening disease severity. The hormone, leptin, which tells us when we’ve had enough to eat, has pro-inflammatory properties linked to autoimmune disorders. (5)

3. The “X” factor

Women have two X chromosomes while men have one X and one Y chromosome. The X chromosome is known to have more immune-related genes than the Y chromosome, which may help explain why women more susceptible to autoimmune diseases. (11)

4. Gut bacteria

Several animal studies have found distinct gender differences in the gut microbiome to be linked to increased rates of autoimmunity in females vs. males. More research is needed to fully understand the connection – until then, improving gut health is a great way to reduce risk of autoimmunity for all individuals, but may be even more important for women. (10)

5. History of pregnancy

One study found that women who have had at least one pregnancy were more likely to be diagnosed with an autoimmune condition than women without children. This link was especially strong for Graves disease, Hashimoto’s thyroiditis, and sarcoidosis. (12)

More study is needed to understand this connection, but we’ve known for some time that immune function decreases during pregnancy to protect the body from attacking the “foreign” baby, and that the chance of autoimmune diagnosis goes up within the year after birth. Pregnancy also significantly shifts hormones and, in some cases, these shifts can exacerbate the symptoms of the disease, while in others such as Rheumatoid Arthritis, autoimmune symptoms can improve. (6)

The Bottom Line

More than likely, you know more women than men with an autoimmune condition. We’re still learning why that is but, until we know more, eating a whole foods diet, maintaining a healthy weight, tending to our gut health, and managing our stress are all important ways to reduce risk for autoimmune diagnoses. 

Read Part 2 of this series: Best Autoimmune Diet + Lifestyle Tips!

About the co-author

Sarah Kaufman is a Dietetic Intern at the University of Houston. She graduated with a B.S. in Human Nutrition and Dietetics at Metropolitan State University of Denver. Through her own personal struggles with nutrition she developed a passion for helping others find a balanced lifestyle in order to achieve great health. 

Disclaimer: Information on this site is intended only for informational purposes and is not a substitute for medical advice. Always consult with a trusted healthcare provider before implementing significant dietary change. Read additional disclaimer info here.  

References:

1. Michael D. Rosenblum, et al. Treating Human Autoimmunity: Current Practice and Future Prospects. Science Translational Medicine . https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061980/
2. DeLisa Fairweather, et al. Sex Differences in Autoimmune Disease from a Pathological Perspective. The American Journal of Pathology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2527069/
3. Lerner, A., et al. The World Incidence and Prevalence of Autoimmune Diseases is Increasing. International Journal of Celiac Disease. https://www.researchgate.net/publication/294419057_The_World_Incidence_and_Prevalence_of_Autoimmune_Diseases_is_Increasing
4. Gisele Zandman- Godard, Elena Peeva, Yehuda Shoenfeld. Gender and autoimmunity. Autoimmunity Reviews. https://www.sciencedirect.com/science/article/pii/S1568997206001716
5. Cojocaru, M., et al. Role of Leptin in Autoimmune Diseases. Maedica A Journal of Clinical Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3749767/
6. Goin, D.E., et al. Autoimmune disease during pregnancy and the microchimerism legacy of pregnancy. Immunol Invest. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709983/
7. Arndt Manzel, et al. Role of “Western Diet” in Inflammatory Autoimmune Diseases. Curr Allergy Asthma Rep. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034518/
8. Alessio Fasano. Leaky Gut and Autoimmune Diseases. Clinical Reviews in Allergy & Immunology. https://link.springer.com/article/10.1007%2F. s12016-011-8291-x
9. Stojanovich L, Marisavljevich D. Stress as a trigger of autoimmune disease. US National Library of Medicine. https://www.ncbi.nlm.nih.gov/pubmed/18190880
10. Yurkovetskiy, L., et al. Immunity. 2013 Aug 22; 39(2): 10.1016/j.immuni.2013.08.013.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822899/ 
11. Bianchi, I., et al.The X chromosome and immune associated genes. J Autoimmun. 2012 May;38(2-3):J187-92. doi: 10.1016/j.jaut.2011.11.012. https://www.ncbi.nlm.nih.gov/pubmed/22178198 
12. Jorgensen, K.T., et al. Childbirths and risk of female predominant and other autoimmune diseases in a population-based Danish cohort. Journal of Autoiummunity. 2012;38(2-3):J81-J87. https://www.sciencedirect.com/science/article/pii/S0896841111000709