Guest Post by Mickey Trescott: What is the Role of Th1 and Th2 in Autoimmune Disease?

January 14, 2013 in Categories: by

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This is the first of two guest posts written on the subject of Th1 versus Th2 dominance in the context of autoimmune disease by Mickey Trescott, blogger behind Autoimmune-Paleo.  The second post will be posted this Wednesday.  But first, let me introduce you to Mickey.  Mickey is a personal chef and blogger from Seattle, WA who has both Hashimoto’s and Celiac disease. She writes about her struggles with autoimmunity, alternative treatments and protocols, and shares many AIP-friendly recipes on her blog. She is busy writing a cookbook for the autoimmune protocol that is coming out early this year (and yes, I will let you all know when it’s released!  how exciting!). You can also find Mickey on Facebook and Instagram.

Those that suffer from autoimmune disease commonly experience symptoms that stem from imbalances within the functioning of their immune system. There are many factors that can influence this balance – stress, nutrition, vitamin and mineral deficiencies, gut flora, and allergies, among others. This way of looking at autoimmune disease is a growing trend in the alternative field, highlighted through the work of Datis Kharrazian.

In this series I hope to give readers a basic explanation of how the T-helper cells work within the immune system, as well as what factors can cause them to be more or less in balance.

What are Th1 and Th2?

T-helper cells (abbreviated as Th) are a vital part of the immune system. They are lymphocytes (types of white blood cells) that recognize foreign pathogens, or in the case of autoimmune disease, normal tissue. In response to this recognition, they produce cytokines, which are hormonal messenger proteins that are responsible for the biological effects of the immune system. They are divided into subgroups as follows:

Th1: Th1 cells are involved in what is called “cell-mediated” immunity, which usually deals with infections by viruses and certain bacteria. They are the body’s first line of defense against pathogens that get inside our cells. They tend to be pro-inflammatory and are involved in the development of organ-specific autoimmune disease.

Th2: Th2 cells are involved in what is called “humoral-mediated” immunity, which deals with bacteria, toxins, and allergens. They are responsible for stimulating the production of antibodies in response to extracellular pathogens (those found in blood or other body fluids). They tend not to be inflammatory and are involved in systemic autoimmune disease and other chronic conditions.

In a well-functioning immune system, both groups of these T helper cells work together to keep the system balanced. One side might become more active to eradicate a threat, then settling back to a balanced level.

How does this affect autoimmune disease?

In some people with autoimmune disease, patterns showing a dominance to either the Th1 or Th2 pathway have been shown. Although there are exceptions, the following table shows the conditions that are most commonly associated with a Th1 or Th2 dominant state:

TH1 dominant conditions:

Type I diabetes
Multiple sclerosis
Hashimoto’s Thyroiditis
Grave’s Disease
Crohn’s Disease
Sjoren’s Syndrome
Celiac Disease
Lichen Planus
Rheumatoid Arthritis
Chronic viral infections

TH2 dominant conditions: 

Allergic Dermatitis
Atopic Eczema
Inflammatory Bowel Disease
Ulcerative Colitis
Multiple chemical sensitivity

When the th1 cells of the immune system are overactive, they can suppress the activity of th2 and vice versa. This can be problematic because these two components of the immune system function in a delicately balanced relationship. In the case of autoimmune disease, imbalance can further the attack on healthy tissue, thereby worsening symptoms.

Although research can lump those with certain conditions under the Th1/2 categories, in reality they can be all over the map. For instance, although most Hashimoto’s patients present a Th1 dominance, some can be Th2. It is also possible to have both Th1 and Th2 simultaneously overactive or under-active. Pregnancy can shift the immune system temporarily to Th2, which is why a lot of women find out they have Hashimoto’s after they give birth and their immune system returns to Th1 dominance.

How do I find out if I am Th1 or Th2 dominant?

There is a Th1/Th2 cytokine blood panel that your doctor can order to find out if your immune system is imbalanced. You can also do a challenge with certain nutritional compounds that stimulate either Th1 or Th2, although this can be tricky and is best done under the supervision of a practitioner.

In the next article, I will cover these nutritional compounds along with other strategies of balancing and modulating the immune system.


Why Do I Still Have Thyroid Symptoms? by Datis Kharrazian 

Immune Balancing for Hashimotos – Chris Kresser 

Research Review: Could Green Tea Actually Be Bad For You? – Dr. Bryan P. Walsh



Mickey- thanks for a great overview of TH1/TH2. I was trained by Dr. Kharazzian and a member of Primal Docs, The Paleo Physicians Network and Dr. K’s Thyroid Connection group. Datis hasn’t used and actually stopped suggesting that practitioners use the cytokine panels for a couple of years. The results were inconclusive using them. He now teaches to check the CD4/CD8 ratio test and use the challenge packets to assess the effectiveness of an herbal protocol to balance a new immune player called TH 17. Since it’s now known that over-activation of TH-17 plays a key role in autoimmune disease and chronic inflammatory disease via activation of Nuclear Factor Kappa Beta, we started looking here to quench inflammation.

NFKB is a pivotal transcription factor that stimulates pro-inflammatory gene expression. When we investigate what activates NFKB, we can appreciate why the autoimmune Paleo protocol works so well to treat the root cause of inflammation. Leaky gut, dysbiosis, SIBO, food sensitivities, stress, and viruses can all activate NFKB and lead to an increased expression of pro-inflammatory genes that code for the production of inflammatory cytokines. The goal is really to root out the triggering source of this inflammatory response by eliminating poorly digested proteins, cross reactive proteins, resolving dysbiosis, SIBO, and healing up your leaky gut. Along the way we can modulate NFKB with botanicals like curcumin and resveratrol. In my practice, I focus on removing the triggers first, healing up a leaky gut and increasing regulatory T Cells to balance the immune system then to further fine tune if needed- I will use challenge packs and run a CD4/CD8 ratio test to assess immune system balance.

Hi Anne,

Thanks for the informative comment. My article was meant to be an intro to the concepts of Th1 and Th2 so that those with autoimmune disease could be aware of it, not an overview of Dr. K’s research and protocols. It is very frustrating to me that he would publish in his book that the way to test Th1 and Th2 dominance is a cytokine blood panel if that was not what actually worked in practice – it really makes me wonder about some of his other ideas and if they work as well in practice as they do on paper. As I am sure you are aware, seeing one of his practitioners is quite an expense with the testing and supplement line he advocates. I know many people personally who have been helped by his methods, but I also know some who feel as though they have spent thousands of dollars and not found help, and some were made even more ill. The immune system is so complex that it is hard to believe that there is a protocol out there that can work for a majority of patients.

I appreciate the information about Th-17 and NFKB, it is something I have come across and will be researching further. I agree with you that the first step is to do an elimination diet and start working on gut health. My next article covers Th1/2 modulating compounds as well as those that stimulate T regulatory cells, which I believe are much easier and safer than stimulating Th1 or Th2.

I wonder if this is why I started having gluten sensitivity when my second child was around 3 months old. I believe I have celiac disease and guess I am not totally healed yet. So are there supplements to bring my body back in check if my TH1 is still overactive? I have been gluten free for about 8 months now. Thanks for your work!

Melanie – I have heard many accounts of autoimmune issues cropping up when people have kids, most likely because the shift in the immune system that happens with pregnancy causes their condition to flare (or in some cases go away!). I don’t recommend playing with the Th1/2 balance without the help of someone who really knows what they are doing, but you can work on immune modulating and T-regulatory supporting compounds (probiotics, vitamins A, D, E, EPA and DHA, and colostrum).

My autoimmune disease (ulcerative colitis) cropped up after my first pregnancy. I also had an MMR booster in the maternity ward after the birth. Dr. Yehuda Shoenfeld talks about ASIA (autoimmune syndrom induced by adjuvant) and Dr. Andrew Wakefield’s controversial research showed a link btwn MMR and Ulcerative Colitis.

My question is how can I find out why I would have two autoimmune diseases which are opposing dominance. I have celiac disease (th1) and Ulcerative Colitis (th2). What am I supposed to do about that?

Dominance isn’t set in stone and more recent research has shown that there’s a lot more to it than th1 and th2. Ultimately, it may be best to avoid all immune-stimulating compounds, or to test them after elimination to find out if any do aggravate you. – Christina, Sarah’s assistant

thanks for your response. i do avoid immune stimulating supplements most of the time. a lot of people in my support groups promote the use of turmeric to control inflammation. since it is immune stimulating, would you say this is worth avoiding?

I was diagnosed a few years ago with Hashimoto’s and PCOS and knew very little outside of taking my daily Armour Thyroid pill. My symptoms have been getting much worse this year, and I began researching more about my diseases. I believe I also have Celiac Disease as well. My question is this…I now see a General Practitioner, and I would like to look for an Endocrinologist who will also embrace holistic approaches to healing. Is there a site to help my search? Or are there certain questions I should ask Doctors when I meet with them before choosing the right Doctor?

Try and If you don’t find anyone local through those directories, look for a physician who uses buzz words like functional medicine and complementary medicine.

I’ve read somewhere that a person can have both th-1 and th-2 rised. Is that possible? I’ve read somewhere else that th-1 and th-2 exclude each other: either you are one either the other. So how is it?

Also let’s say my tests show I’m th-2 dominant so I make antibodies to my thyroid. But what I know for sure is that my immune system attacks my thyroid so doesn’t that mean that I’m making NK and cytotoxic T cells (from what I’ve know this cells are the ones that actually make the attack), so I’m Th-1 dominant also?

Can you please help me? I’m really confused.

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