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How to Choose Your Autoimmune Clinician: Things to Consider

Written by Dr. Michael Ruscio, DC on December 20, 2021

Written by Dr. Michael Ruscio, DC on December 20, 2021 — Reviewed by Heidi Turner

Everything You Need to Know About Finding the Right Autoimmune Clinician

• Types of Providers|
• Red Flags|
• Questions to Ask|
• Autoimmune Disease Basics|
• Autoimmune Disease Treatment Guide|
• Bottom Line|

Autoimmune conditions are individualized and often complex. It’s estimated that the average patient with autoimmune disease sees six doctors over the course of five years before receiving a correct diagnosis. Finding the right autoimmune doctor can really make a world of difference when it comes to improving your symptoms, quality of life, and overall health. But how do you find the right autoimmune doctor for you?

While there are a variety of practitioners skilled in treating people with autoimmune diseases, such as rheumatologists, dermatologists, and immunologists, the key is to find a clinician who is open-minded, balanced, and willing to be a partner in your health journey. Your autoimmune doctor should blend scientific evidence with clinical experience to create the best plan for you.

In many cases, the best approach for people with autoimmune conditions is to work with both a conventional and an alternative or integrative provider. In this article, I’ll outline red flags to look for, questions you can ask when looking for a clinician, and what to expect from different types of autoimmune doctors. And whether you’re working on healing Hashimoto’s, inflammatory bowel disease (IBD), rheumatoid arthritis, or any other autoimmune disorder, I’ll also include a quick guide to the natural healing approach that we’ve found most effective in our clinic.

What Types of Providers Treat Autoimmune Conditions?

Because autoimmune disorders can affect every system and part of the body, most providers have treated patients with these conditions. But there’s a huge difference between treating someone and helping them both heal from troubling autoimmune symptoms and get to the root of their autoimmunity. 

To achieve the greatest success, It’s important to find healthcare providers with a variety of tools in their tool box. Conventional and integrative providers will both be able to offer help for those with autoimmune disorders, but they usually differ in the approach.

• Conventional providers often use anti-inflammatory and immunosuppressive or immunomodulatory medications to address an out-of-control immune system. While these medications are sometimes necessary, they may cause side effects and don’t always address the root cause of the problem.
• Integrative providers (naturopaths and functional medicine providers) often use dietary strategies and supplements along with lifestyle modification. Natural therapies can be extremely effective for people with autoimmune diseases, but in severe disease, these therapies may not be enough.

The best solution for most people with autoimmune diseases will likely involve a team of both conventional and integrative providers. Your conventional doctor can help you with a medication protocol or other standard therapy as appropriate, and your integrative or functional medicine provider can guide you on nutrition, dietary supplements, gut health, and lifestyle wellness strategies.

Red Flags to Look For When Choosing an Autoimmune Doctor

Choosing the right providers for yourself can take some work, but when you’ve found the right healthcare team you can experience more complete healing. There are several red flags to consider when choosing your autoimmune doctor:

• Fear mongering: Your doctor shouldn’t make you feel like your condition is worse than it actually is and should never scare you into making treatment decisions. Fear and psychological stress are autoimmune disease triggers and can worsen autoimmunity and other conditions [1].
• Overzealous and/or absolutist statements: There is no one right plan that’ll work for everyone with autoimmune disease. If your provider says there’s only one type of diet or one medication option, steer clear.
• Unwilling to consider a variety of options: This can happen with both conventional and integrative providers. Conventional providers may be unwilling to consider natural therapies and integrative providers may be unwilling to consider the addition of medication. Bottom line, if your provider isn’t willing to alter their treatment plan or explore new options with you, they’re probably not the best choice. 
• Ignores the evidence: Both conventional and integrative providers can get caught up in theory and forget about the research. A great example involves the over-prescribing of thyroid medication for those with Hashimoto’s thyroiditis. Hashimoto’s is an autoimmune condition and the most common cause of hypothyroidism, but only 9% to 19% of Hashimoto’s patients actually go on to develop hypothyroidism. Despite this fact, many providers still prescribe thyroid medication for all Hashimoto’s patients [2].
• Over-reliance on test results: If your provider is more interested in the numbers than on how you’re feeling, they’re likely not the best candidate for you.
• Overly confident: If your provider claims they can cure your autoimmune disease, continue your autoimmune doctor search.

What Questions Should You Ask When Choosing Your Autoimmune Doctor?

Searching for a provider can be daunting if you don’t know what topics to discuss. I’ve made it simple by providing you with a list of helpful questions to get you started.

It’s worth noting that conventional practitioners, including rheumatologists, may not have as much time available to answer these questions in addition to their full intake. If that’s the case, consider which questions are most important to you from the list below, and start with those.

Time constraints aside, if your potential provider displays any of the above red flags or is unwilling to discuss the following questions, you’ll probably want to continue your search.

1. What can I expect from my first and second appointments with you?
2. Are you open to both natural and conventional therapies when used appropriately?
3. Will you tailor your treatment plan to fit my needs and lifestyle?
4. Can I reach you if I have questions about my treatment plan?
5. Are you willing to communicate with a team of providers?
6. How do you decide which treatment to offer first?
7. How do you determine whether the treatment plan is working?
8. Are you open to changing the treatment plan if I feel it isn’t working for me?
9. If I have to take medication, are you willing to stop the medication if I feel I no longer need it?
10. Are you willing to use dietary supplements instead of medication?
11. How much experience do you have in treating my specific condition?

Autoimmune Disease Basics

The immune system functions to protect the body against disease and infection. But in people with autoimmune disease, this system is altered and the body is unable to recognize friend from foe. The body’s immune system begins to attack healthy cells, tissues, and other body parts and over time, these immune system attacks can lead to poor quality of life, as well as a variety of complications and ongoing symptoms. but also permanent damage and debility.

There are now more than 100 types of autoimmune diseases that have been identified [3]. Some common autoimmune diseases include:

• Autoimmune hepatitis
• Autoimmune thyroid disease
• Celiac disease
• Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
• Multiple sclerosis
• Psoriasis and psoriatic arthritis
• Rheumatoid arthritis
• Scleroderma
• Sjogren’s syndrome
• Systemic lupus erythematosus (SLE)
• Type 1 diabetes
• Vasculitis

While all people with autoimmune conditions experience different symptoms, some of the more common symptoms of autoimmune disease include:

• Muscle weakness
• Dry eyes
• Hair loss
• Musculoskeletal pain
• Joint pain and swelling
• Skin issues
• Fatigue
• Digestive problems
• Difficulty concentrating
• Sleep disturbances

A Step-by-Step Treatment Guide For Autoimmune Diseases 

At the clinic, we’ve developed a treatment hierarchy that’s been extremely successful for our patients with autoimmune disease. Moving in a stepwise fashion through this hierarchy allows for personalization of the treatment plan. If you achieve symptom reduction and are feeling great, there’s generally no need to move to the next step in the process unless your symptoms persist. 

Step 1: Find Your Ideal Diet and Work on Healthy Lifestyle Changes 

As I discuss in Healthy Gut, Healthy You, diet is extremely important for gut health, but it’s also key for those with autoimmunity. There is no one diet that works for all people though. I generally recommend starting with a Paleo diet because it’s pretty easy to implement, helps to calm inflammation, and minimizes your exposure to foods that can increase the inflammatory response. But some people with autoimmune disease achieve similar results with other meal plans. It’s really about finding what works best for you. 

Addressing sleep, stress, and exercise are just as important as nutrition when it comes to healing your autoimmune symptoms. Here are a few of my top tips:

• Avoid toxins to the best of your ability
• Obtain appropriate sun exposure
• Spend time in nature
• Exercise, enough but not too much
• Walk as much as you can
• Get enough sleep 
• Mitigate stress, and/or practice stress management techniques
• Nurture healthy relationships and social connections

Step 2: Add Probiotics and Anti-Inflammatory Nutrients 

The health and function of your immune system is closely tied to your gut health. When there’s imbalance in the gut, your immune system can be forced into overdrive, possibly worsening your autoimmune symptoms. Probiotics help to balance the organisms in your gut and in doing so, can help calm the immune response [4].

Anti-inflammatory nutrients like omega-3 fatty acids from fish oil, curcumin, and vitamin D3 can also be added in step 2. 

• Omega-3 fatty acids (fish oil) have been shown to provide powerful anti-inflammatory benefits. In one randomized controlled trial, patients with rheumatoid arthritis who took fish oil supplements for three months experienced significant improvement in joint pain and morning stiffness [5].
• Curcumin, a bioactive component of the spice turmeric, has long been used in alternative medicine for its anti-inflammatory properties. In one systematic review and meta-analysis, supplementation with an average of 1,000 milligrams of curcumin per day was considered efficacious for joint arthritis, including rheumatoid and psoriatic [6].
• Vitamin D3 is a powerful modulator of the immune system and many patients with autoimmune disease are vitamin D deficient [7]. For my autoimmune patients, I like the vitamin D level to be as high as 50-60ng/mL, and I prefer natural sunlight as the main source of vitamin D. But this isn’t always feasible, so I often recommend a conservative dose of vitamin D3 (2,000 to 4,000 IUs per day) in combination with vitamin K2. If you’re on blood-thinning medications, you should consult your doctor before taking a supplement that contains vitamin K.

Step 3: Specialized Alternative Therapeutics

While nutrition, lifestyle, and anti-inflammatory nutrients can often provide significant relief, some people with autoimmune disorders require some additional therapies. 

• Elemental diets: An elemental diet is a liquid diet that can be anti-inflammatory and reparative. This type of diet provides a balance of essential proteins, carbohydrates, fats, as well as other nutrients. The components are broken down and thus easier to digest. When it comes to autoimmunity, elemental dieting has been found to be as effective as the anti-inflammatory steroid drug prednisone in patients with rheumatoid arthritis [8].
• Antimicrobial therapy: Gut microbiome imbalances are common in those with autoimmunity. If you have tried probiotics and are still struggling, you may benefit from an antimicrobial protocol to further address imbalances. 
• Immunoglobulins: Immunoglobulins are naturally present in your gastrointestinal tract to bind to and deactivate irritants that can cause inflammation and leaky gut. People with autoimmune disease may benefit from supplemental immunoglobulins to help reduce inflammation and prevent overstimulation of the immune system. 

Step 4: Consider Prescription Medications 

If you’ve worked through the first three steps but haven’t achieved your desired results, step 4 may be necessary. Work with your autoimmune doctor to determine if anti-inflammatory, immunomodulatory, and/or immunosuppressive drugs are right for you.

The Bottom Line

Your autoimmune doctor should take the time to listen to your concerns and work with you to develop a personalized plan just for you. Since autoimmune diseases are complex and individualized, they’re best treated by a team of providers, both conventional and integrative. 

Patients with mild to moderate autoimmune symptoms often experience significant relief and improvement with natural therapies alone. For those with severe disease though, natural therapies may not be enough and medication could be necessary. In our experience in the clinic, nutrition and lifestyle strategies often allow even patients with severe autoimmune disease symptoms to use lower medication doses and/or decrease the amount of time on the medication. 

If you have gone through the step-by-step treatment guide above and are still struggling with your autoimmune symptoms, contact the Ruscio Institute for Functional Medicine.

The Ruscio Institute has developed a range of high quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.