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- เผยแพร่เมื่อ 30 พ.ค. 2024
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Our immune systems are wonderful things-if they work properly. Sometimes, they can turn on us and create challenging autoimmune diseases & conditions. Unfortunately, these autoimmune issues primarily affect women. Why is that? Join Hank Green for a new episode of SciShow and dive into the world of the immune system!
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THANK YOU for this video! 💕
This is SEXIST! You are basically saying men's hormones are better than woman's with a twisted end!
I am a man
@@TheDigitChannel you are a complete idiot if that is what you got from the video. Feel ashamed, feel very ashamed. Watch it again, and pay attention to all of it this time.
I'm American 😢
My thyroid: * exists *
My immune system: idk about that fam, seems pretty sketchy
Same
Hashimoto’s thyroid since puberty
@@Neriedar and Erin - thyroid warriors, keeping it real.
My imnune system: I don't knows what it is. I'll better destroy it... Oh, you needed this organ? Uhm, well, sorry... 😂
Erin Myers same!!!! I got Graves’ disease at age 19
And people tell you "But you don't LOOK sick...."
no, you totally look sick
Laughs in mental illness
Ughh I hate when people say that 😂
That always gets me, too, along with "You don't look disabled," and "You don't seem autistic." I'm never sure how to respond. Should I be carrying my genetic tests, medical files, and prescriptions?
Jeff Miller
My autism only comes up when I’m about to get myself into trouble
I am a transgender man with a rare autoimmune disease that kills my platelets. When I started testosterone hormone therapy, my platelet levels went up to normal and have stayed that way, even when I am not on hormones. I always thought that was interesting, given the gender divide.
I've heard some similar things from other transgender men with EDS and POTS. They suffered fewer joint dislocations and their syncope attacks lessened, just from starting T. Nothing else was changed in their medical treatment.
Wow that’s fascinating. Thanks for sharing!
I wish it could have saved my sister-in-law who suffered from CREST.
I wonder how effective this could if used at super low dosage that wouldn’t affect other parts as a partial or permanent cure.
Thanks a lot for sharing!
It’s so infuriating to be brushed off and not taken seriously with our medical concerns. My sympathies for those who have suffered for years before getting a legit diagnosis and treatment.
As a woman the most common comment I’ve heard (mainly from so-called medical professionals) is, “It’s all in your head.” That isn’t always the exact wording of what’s said, but that’s typically the gist of what they’re trying to convey.
This is especially true when alluding to pain. I’ve had a long history of mismanagement when it comes to healthcare and it’s effects are everlasting. I put off going to see a doctor or seeking medical attention unless ABSOLUTELY NECESSARY. Part of that is also due to how costly healthcare in the U.S. is, but mostly because of the dismal treatment I’ve received from medical practitioners throughout my 38 years of life thus far.
If I had the means to afford 2nd, 3rd, and 4th opinions I’d jump at the opportunity. The medical industry has a long history of putting women through the ringer and dismissing our symptoms as “hysteric claims”. Shame we’ve still got a ways to go.
I have a few invisible illnesses. I have found that asking all of the medical assistants, nurses and doctors who they see for primary is a good method of finding doctors worth seeing.
Hospitals right now don’t like giving strong pain relief. It’s an effect from some places giving them away to easy causing addiction problems.
Now we might have people being too suspicious. There isn’t a test for pain. Doctors can only go on how you act.
I would recommend sunlight though. It can really help with chronic pain. It releases morphine like chemicals in your body.
My mom spent decades with absolutely awful periods. Whenever she asked a doctor “hey, is this normal” or something they would brush her off. It wasn’t until she was almost 50 that a single doctor finally took her seriously, and ran a couple tests. Yeah, turns out her uterus was super messed up. Like, a massive cyst and some other stuff. But by then she was almost at menopause so there wasn’t much point in figuring out what was going on. But it just infuriates me that her uterus was super messed up for decades, and no one even bothered to look at it until it was too late to bother doing anything about it
Can confirm. My doctors said they couldn’t find a reason for all of my pain until I ended up in the ER where they found a kidney stone the size of a cell phone (8cm by 5cm) and, I’ll use the surgeons term “massive” calcified fibroids. Five surgeries later…..
@Amazon 213 I've seen my parents absolutely crippled by pain from (relatively small) kidney stones. I cannot imagine how much yours must've sucked 😭
Summary of this lesson:
X gon give it to ya
It took me a minute, but that's a really clever one there
this made my day
I love that
Oh god :,,D
Thx now i don't have to watch the video
My bone marrow: helps the immune system
My immune system: seems sketchy. Let's take it out.
Damn my immune system self sabotaging as much as I am
Isabelle Harvey 🤣😂
The betrayal!
Marie S. definitely on my top 10 greatest anime betrayals.
IT'S A COUP!!!!
I feel like comparing the rate of autoimmunity in places where rates of pregnancy have decreased versus where they are higher would be interesting
I wonder how many pregnant men have auto immune issues 🤔
Funny how some people think that they are being edgy are actually just being stupid.
@@Sarah-said an expert in stupid huh very impressive
I think it would be better to compare groups from the same place who have similar medical problems and ages but different numbers of pregnancies. Fewer confounding variables.
I would say that study should be isolated to pregnant women then compared against another excluding pregnant women. This second part should not be taken into consideration with the first if we want comprehensive results.
I'm 75% sure I have rheumatoid arthritis which is a degenerative disease and is extremely prevalent in my family but I haven't been able to seek out diagnosis because doctors don't take me seriously as a women and won't even entertain testing me for it. It's really horrible suffering from chronic pain and feeling unable to talk about it. I've given up and just bear with it now.
Update: First I would like to thank everyone for your kind words and support in the comments. I am 25 and I first suspected RA around 19. The reason for this update is that I recently suffered an extensive DVT and PE which is med speak for a whole lot of blood clots. I almost died. I am now seeing a hemotologist for blood testing to check for genetic factors and I mentioned that I have had chronic pain and though I ask doctors for testing for RA they had laughed and dismissed me. My results show that I do in fact have RA but it took me nearly dying to get there. Women's pain is systematically ignored. I still have not been prescribed pain relief and some days I can't walk. This needs to change. Thanks again for all the support!
totally get if the energy it takes to do this is just... too much but: try seeing a new doctor if possible, explaining the symptoms, and saying "a friend suggested that this might be rheumatoid arthritis, and when i talked to my family about it they said [xyz close relatives] have it. could you tell me more about it?" it's annoying to do, but a lot of chronic pain friends and i have had luck with this method when doctors weren't taking us seriously. if they still are being terrible, request that they note on your chart that you asked for testing around it (ie rheumatoid factor, inflammation) and that they refused to do it. the first method tends to work with doctors who like feeling smart, and the second with ones who fear being sued. i actually ended up being wrong, which was... ugh. it took even more time, but eventually a new PCP suggested fibromyalgia and that's explained *so* much. good luck, and i hope things work out for you and anyone in similar circumstances
It took me 6 years to get a diagnosis for the same reason, so I feel your pain. I’d say don’t give up - see if you can find a good Dr, there are some out there. Even though living with RA is still very hard for me, medication has definitely allowed me to have a much better life than I did before. Good luck
I was diagnosed when I was 3 and a 1/2 (w/JRA then my diagnosis was changed to JIA in my teens) thankfully because I got very very sick and was in the hospitalfor several days. If you haven't yet confirmed diagnosis one of the things I highly recommend is swimming, if you have a pool, swimming is the best exercise for people who have arthritis. Take glucosamine chondrointin and make sure you're also consuming a lot of omega 3s as it helps against inflammation. I also consume higher amount of anti-inflammatory foods (cinnamon, turmeric, garlic, etc) for good measure. Some people have the rh factor and that's how I got diagnosed when when I was little but I was recently retested and I no longer have it but I don't think that means I don't have RA any more. 🤷♀️
Good luck, people will not understand what your going through but they don't have to. You're the one who feels it and thats enough. ❤
I’m still trying too. The doctors have been downright cruel. Saying I’m too emotional is the reason. I had a life threatening infection! I was tested 4 times and they never cultured until the last time, but told me they did.
Try this phrase, "I want it noted in my chart that you are refusing to run tests that may lead to diagnosis, or treatment options". It's helped me repeatedly.
This is funny because after I was pregnant, my immune system decided that mosquito bites are super very dangerous and I get super sick from them now. Thanks, biology!
That's why I don't want children. Pregnancy can damage your body in so many ways.
After my pregnancy, my body decided pineapple and kiwi were sus and I now get anaphylactic reactions from them.
Kiwi is easy to avoid, but pineapple is way more common than people realize and pineapple juice is becoming common as a “natural sweetener” in sauces and drinks.
My own mom tried to end me with a carrot cake that had pineapple in it. Lol.
MCAS can be related to connective tissue disorders, which are made much worse by pregnancy hormones!
After my first pregnancy I got an autoimmune disease that almost killed me and resulted in me having my large intestines removed from my body. After one more disastrous pregnancy I have sworn off having more kids.
@@chiaraosment4212Jesus,,, hope your doing better tho ❤ plus there’s always adoption if you want another little bugger 😅
As a biological male with a pretty severe autoimmune condition, I had always wondered why almost everyone I had met with my condition was a women. I had thought maybe it had something to do with men visiting doctors less often the women and being less willing to seek out treatment for illness. I had no idea it was to this scale however or that my subjective experience had wide reaching implications. Really appreciate the work you guys do to keep us informed and educated on the science of medicine and human biology. Really cuts through a lot of the less reputable sources that spew questionable information.
It has to do with medical sexism and ableism surprisingly. Medical concerns aren’t explored by doctors and they just throw us out. Then we stop going to doctors because we give up at some point. Like it took me 7 years for a diagnosis of anemia and menorrhagia. A common chronic condition amongst women and easy to diagnose. I went to multiple GP’s too.
@@marley7659 I had a similar issue with pernicious anemia. They tried telling me I had lupus etc. I literally JUST needed vitamin B12 injections
My therapist has told me quite a lot about how researchers are only recently understanding that childhood ab*use and adverse childhood experiences (known as ACEs), can strongly affect the development of autoimmune disorders, and some other specific physical disorders in adult life.
Apparently there's a really strong statistical link between these things, and despite this, it took the medical world a long time to accept that this was the case.
I do wonder if girls experiencing more ACEs could go part of the way to explaining this.
@@AimeeColeman Of course. Stress negatively effects the immune system.
@@AimeeColeman Actually, women are more likely to have autoimmune disorders due to biological women possessing two X chromosomes. Two X chromosomes = greater chance of mutations occurring = greater risk of autoimmune diseases. Studies with mice have even found similar results with female mice and male mice who suffered from Klinefelter syndrome (which means they have an extra X chromosome) being shown to be more likely to develop Lupus and Sjorgen's syndrome (they even developed them at similar rates). Times in which hormones shift a lot are also factors too (specifically when women go through puberty, pregnancy, and menopause, which are the periods when most autoimmune disorders arise in women).
My brother and sister had allergies, especially my brother, when we were kids. Once they got away from mom, allergies subsided. (Mom was rageful and we were always stressed out.) I think stress plays a role.
Stress is 1000% a factor in auto immune responses. If you are in fight or flight, your immune system is on high alert, and if its always on high alert, autoimmune diseases are just waiting to happen.
Stress of any kind is believed to be responsible for turning on gene(s) that cause different forms of autoimmune disease. Mental or emotional stress from abuse, difficult living situations could cause this to happen as can other types of stress- infections, not enough sleep, lack of nutritious food, pollution, regional conflicts and war, etc. It's unlikely that only one type of gene is responsible for any given autoimmune disease.
yeah i also have an auto immune condition and whenever I'm stressed or anxious, my condition flares up
Do you know how your brothers condition changed when he hit puberty? Or was it already all gone by then?
I agree it does...
I was diagnosed with Grave's Disease IMMEDIATELY after my son was born. I had been feeling 'off' for years and was told at one point I had a goiter but never got the chance to investigate it. I got pregnant soon after and felt FANTASTIC. It had been years since I'd felt that good. My son was born and my body went bat-guano crazy. I had a heart rate of 150 bpm AT REST. No one could figure out why until I mentioned the goiter and suggested they check my thyroid.
It makes sense now why I felt so good during my pregnancy. My body corrected itself for my son and crashed when it didn't have to anymore.
I have Hashimoto’s and never made the connection that I had good pregnancies but totally crapped out shortly after weaning. It was “just stress” and “of course you’re tired with two small children.” It took until they were in K and Pre-K to get tested 😒
I’m glad they finally listened to you 😊
My skin * exists *
My immune system: “ya, gonna have to get rid of that”
Me: 😢
Olivia Green Same! Psoriasis man it’s ~fun~. A new patch somewhere else all winter long, like an extended Christmas gift lol
Then there's the constant paranoia every time a joint feels a bit stiff or sore that the psoriatic arthritis is going to show up.
@@KeyLimeadeish oh it prob wont feel stiff It will be pain! I developed PsA a couple of years ago with a full body flair it and the first joint that I later realized was the start was that I thought I hurt my knee. Then over the next couple of weeks it want from a joint being in pain every couple of days to having multiple joints in pain every day to the point that some days I could not walk and some days I could not use my hands it just depended on the day. It was super not fun but I have been under control with meds and two years of Physical therapy (bc US insurance only lets you go to PT for one joint at a time) and I am back to a functioning human but still working up to the strength that I had 4 years ago. Also bc the stronger my joints are when ever I have another flare the less damage it will cause.
@@VictoriaFaye09 Does eating garlic make it go away temporarily?
Ever tried the Candida diet?
My Bain *exists*
My immune system: Well, we can't have that now, can we.
Me: *Can't walk in a straight line anymore*
I’m a girl with Hashimotos (attacks the thyroid), and a while back I was having issues. My hair was breaking really badly, my cycle was off, always tired, etc. My mom and I thought my numbers were probably off, and got them checked.
Turns out, I was Vitamin D deficient. Being deficient in Vitamin D can mimic symptoms of autoimmune disorders. Get your sunlight, stay safe, don’t stress.
How vitamin D deficient were you? Did you get more vitamin D and if so did that fix your complaint?
@@Fomites probably very. I used to be deficient too. Was more chronic fatigue, headaches and nausea.
That’s really interesting. My mom has hashimotos and was recently very vitamin D deficient too.
Just going to the sun won't be enough. You have to supplement.
Moving to Maui helped so much of my issues, but I found out I have POTS which is triggered by heat 😢
This is fascinating. I have hEDS and a bunch of super 'fun' comorbities and what my doctor thinks is an undiagnosed autoimmune problem. I'm also transmasc, and my health DRAMATICALLY improved when I started testosterone. I've always wondered if it was more than just 'being happier' that did it, and after talking with a lot of other chronically ill transmasculine people it's common across the board that our health improved. Really hope this gets investigated more.
Also thanks for the inclusive language in the video :)!
That is fascinating! I'm also transmasc w/ hEDS, but I haven't started testosterone yet [I have cardiac issues aside from POTS & a worrying JAK2 mutation that raises my risk of "what if blood but too much?" issues, lol]
and in reverse, while part of her health greatly improved because her body was finally recognising the hormones in her body as the right kind, when my bff started taking testosterone blockers her health took a really big hit. her energy as well. she also meets the qualifications of Heds (after I got diagnosed and she was suprised that many of my symptoms weren't normal lol) and comorbidities like POTS. hormones are crazy
Omg same! I took testosterone for a year and during that year my health got so much better, even my chronic pain! It didn't go away or anything, just better but it was astounding. I honestly just chalked it up to better mental health = better physical health as well lol.
@@oleanderhawthorne510 That is awesome!
*crossing all of my fingers & toes that I can at least microdose T for a while, so I can have some relief from my chronic pain in addition to the fkn crippling dysphoria*
@@ZijnShayatanica still haven't had any doctors be able to find out what's causing my pain so not quite sure if yours will get better too, but I sincerely hope it does! Living with chronic pain is so difficult, everyone who has it deserves better.
I have about 7 autoimmune diseases, the worst being one that attacks my spine. I’m on disability and some days struggle to walk. Don’t underestimate this stuff, don’t ignore people when they say they’re in pain and something is wrong, even if you think they look fine. People like to think that they are healthy because they do all the right things, and like to believe they can exercise or eat clean their way out of chronic illness or pain if it ever happened to them. It’s one of those grasps at control I think, the idea that good people earn good health, and disabled, chronically Ill people just aren’t trying hard enough. This is the root cause of so much ableism I think, the idea that it could NEVER happen you YOU. Rethink the way you view disabled people, because you’re one gene or car accident away from living in our shoes, and you would want to be listened to and treated with respect.
When birds sense one of the flock might be sick, they bully him until he leaves. Humans arent much better. We would rather believe the disabled are just bad ppl than to have fear it could easily happen to us too!
You wouldnt believe the amount of ppl who think i could be cured if i just meditated, went to a chiropractor, did physical therapy, tried acupuncture, dieting, etc etc... all things i already tried 🤦♀️ now a friend keeps insisting on me taking deworming medicine 🤦♀️🤦♀️🤦♀️ afraid of the vaccine but thinks deworming medicine cures ppl of everything 🤨
Dysautonomia is now being taught in med schools and as a separate sub-specialty course. The cause of your ills may be a dysautonomia, or an autoimmunity, or an "inborn error" (genetic flaw), or just a vitamin/mineral deficiency. Mix and match is also possible. Treatment for illness A may affect illness B and so on - it generally takes years of visiting various specialty doctors before everything is correctly identified - then you start on figuring out to solve/mitigate it all. I'm sorry your life is not as you desire it to be and wish only the best for you...but, damn the bad luck! and "good hunting"
I also have a bag of autoimmune things including ankylosing spondylitis which attacks my spine - I use a power wheelchair in order to be able to work my job, but its HORRIBLE. Sending you hugs.
@@kayallen7603 Been a year since I left this comment and I can tell I was going through it for sure, you're bang on actually. I have dysautonimia, POTS, and the genetic flaw is Ehlers Danlos Syndrome, it was causing the crippling inflammation and fluid in my spine because my ligaments aren't working properly. How I cleared my savings account time and time again trying to figure this out seeing dozens of specialists, and you got it pretty bang on from a YT comment? great work haha. Yeah EDS is brutal in your younger years if you have it severely, and gets better with time usually. I'll be okay now, I'd say 80% of the distress was not knowing what the hell was crippling me, and constant medical mistreatment due to my age and sex. Thanks for the kind wishes:)
Explaining my autoimmune condition is always fun, because I get to watch people's faces when I say the words 'Hemophagocytic Lymphohistiocytosis' and then summarize it as 'my white blood cells went rogue and tried to kill me'. Like somehow the big red self-destruct button got pushed.
My brain hurts just looking at that name... I wonder who determines the name for these things cause holy cow
I’m in a similar situation with Undifferentiated Connective Tissue Disorder. It’s basically Lupus, RA, sjogrens, and scleroderma all in one. Many people with UCTD just say Lupus because it’s easier.
I did my bachelors thesis on development of a gene therapy against HLH. Whenever anyone asks I refer to the Video Max the angry Macrophage 🤷♂️😅 and Im proud to be able to repeat hemophagocytic lymphohistiocytosis three times flawlessly 😂
We tend to say HLH, mind.
Juicy Pear The nomenclature of diseases tend to be either of Greek/Latin derivation or after the person that discovered them.
There also diseases named after the places the first outbreak occurred.
Brainerd Diarrhoea, Bornholm Syndrome etc;
Or just after the virus or bacteria that causes the illness.
Ebola, aspergillosis etc;
This reminds me about how autism seemingly appears more in men but it’s incredibly under studied in women (and often presents very differently in women so it’s either missed or, in the past, has not been seen as autism)
Good point. Much like how ADHD was only diagnosed in boys for so long, way back in the day.
@@JenOween I have a couple of female friends with ADHD diagnosed in adulthood as was my spectrum disorder. They never considered me to have Asperger's, as it was called then.
that is why lots of women are being diagnosed now at adult age!!! It's not that there are less autistic women, it's that they never cared to understand autism in women
It's 17 people lol.(excluding public figures and myself)
@@haruno21real
I am a woman with MS. You talked about cells being exposed to stress that can cause the cells to activate some of the inactive parts of the cells (time stamp (9:40). Just thought that was interesting, when I was diagnosed with MS, my doctor asked me if I was hospitalized at any point in my childhood (I was, hospitalized for 5 days with pnuemococcal sepsis when I was 5 years old) My doctor said there was a correlation with a serious illness as a child and having MS later in life. Works with the that theory.
yeah i also have an auto immune condition and whenever I'm stressed or anxious, my condition flares up
Trauma in general, especially chronic trauma correlates with higher rates of serious medical conditions later in life & autoimmunity is one of those common issues. Serious medical issues are traumas to the body not to mention they also have the potential to impact us at the mental health level as well.
I personally suffered a failure to thrive problem as a newborn due to my mom suffering depression during pregnancy & after my birth (she lost her 5 month old while pregnant with me). I often wonder how much that particular event, the distress of developing in the womb of a depressed mother & her inability to care for me after birth, may have started my body off on a poor health trajectory.
I started suffering joint pains as a child, before I was even 9yo.
I’m not knowledgeable about autoimmune conditions specifically, but many chronic conditions are considered worsened or more likely to develop if you’ve had ongoing stress or a traumatic event in your life.
With fibromyalgia for example, one of the MAIN risk factors is ongoing physical or mental stress. Almost every patient with fibromyalgia is mentally ill and/or had long-term, unresolved physical pain before the condition fully developed. The current thinking is that pain receptors (emotions like depression are also shown as “pain” in the brain) start to malfunction under the continual stress, causing miscommunication between the brain and body and therefore causing the condition.
And this kind of finding applies to so many (non-genetic) body-wide conditions
something similar happened to me. I got H1N1 when I was 13 years old and never recovered. it took 10 years to get a proper diagnosis (POTS). It's the sickest I've ever been and definitely a moment of extreme physical distress. I always feel my absolute worst when I'm stressed out, whether that's physically from exercise or mentally from something really stressful in my life. I hope your MS is under control. I know how much of a pain that can be
Interesting. I had my tonsils removed when I was 5, in the process of receiving an MS disagnosis
I developed Coeliac disease (heavily diagnosed in my dad's side of the family) around 7 years old, when my parents split up. I have my bets on trauma/stress triggering autoimmune diseases. From there I've dealt with all sorts, one of the first things being social anxiety from the symptoms of coeliac and the reaction of those around me.
I too developed alopecia areata soon after a traumatic seizure and I’m convinced that was the trigger. My sister developed MS during a very traumatic part of her pre-teen years when my parents had divorced and she was under a lot of stress. Stress definitely plays some role, though I’m not sure what.
That is interesting. I developed coeliac disease at the age of 17 around the time I went on the pill... definitely makes me think
@@amelialennon5803 that could be related to it, yeah! I've not done any research on that sort of thing being a trigger, but sounds interesting.
i developed ulcerative colitis at the worst point in my previous (emotionally abusive) relationship. even though in theory it has been proven (or not proven) that high levels of stress don’t cause IBD
I was diagnosed at 28..... Man, it sucks.... I just want to eat anything!!!!!!!!!!
The stress thing makes a LOT of sense to me. I have psoriasis and eventually developed psoriatic arthritis (years after this incident) and it was quite bad when I had a job when my boss was...Ummm...”Difficult”, let’s say. My abdomen had a couple of hand-sized areas and my arms were 3/4 covered from elbow to wrist on the outside half. Within a WEEK of that person leaving the company, my stress level had dropped to near zero and my psoriasis was surprisingly, 100% GONE. Every last single spot disappeared! I was completely shocked. I knew stress made it worse, but I never imagined a lack of stress could clear it completely! Now, I am somewhat able to keep it suppressed through mindfulness and meditation (and a new job).
I'm so happy for you 🙏
I'm so glad to hear you've stayed in remission!
Same here. I moved to leave a bad job (and boss) and within a month or so my psoriasis was completely in remission. I thought it was the climate difference, but now that I've moved back to the area, the psoriasis hasn't returned!
I wonder if any studies have been done comparing the percentage of autoimmune issues within a population between a very stressful society vs one less stressful? Let's say comparing the U.S. to the E.U.
Vitamin D deficiency may be playing a role in a lot of people. There are connections with many autoimmune disorders and even with stress.
Shout out to Crohn’s disease! Always there, and always cramping our style!
Eyoo Ulcerative Colitis here!
It really did my guy alfred the great dirty
I'm a fellow Crohnie! :) This is an interesting video.Crohn's is usually seen as an autoimmune disease. I have read that it isn't a true autoimmune, but very similiar. Autoimmune is the immune system attacking your own body. I've read that some research has shown that in Crohn's patients the immune system isn't attacking our own bodies. It's the immune system going overboard fighting normal bacteria in the intestines and can't shut itself off. So the damage to the intestines is like collateral damage not the target. But, it's so similiar to auto immune and many of the same meds work.
Woah, rambling... I wrote all that to get to the point that I've always been told and read that Crohn's affects males and females in the same amounts. Basically 50/50. I wonder why one disease would affect us equally. While another affects one sex more. Anyway, I'll stop rambling... lol
Edit: I didn't English gud...
Special shout out to psoriatic disease for making my life itchy!
I got my ostomy four years ago
One of the reasons I met my best friend is that we’ve both had our nervous systems hit pretty hard by autoimmune disorders. He is intersex, and I’m mentioning it here because even though autoimmunity is very common in intersex people, he has a lot of difficulty finding doctors that will take him seriously because of his gender. Especially while living in areas that are not very kind to trans and native people
When my mom was pregnant with me and with my sister, it was one of the few times that her MS calmed down. However, it got much worse for years after I was born.
Two years ago I had Graves’ disease, immune system just starts attacking your thyroid, there was no clear trigger except that I had lost a close friend so you might say “stress” (though one common trigger is pregnancy so clearly that’s a not always protective for every autoimmune disease). The weird thing about Graves though is often when you treat the resulting overactive thyroid, sometimes the autoimmune just....stops.
That’s what happened to me and I have to say after that whole year I’m convinced they haven’t the slightest idea what’s going on. Just told me to “avoid stress”. Sure mate, I’ll be sure no one I love ever dies again.
I too also have Graves Disease and mine was triggered by the brain surgery I had 2 years earlier. I was told that Autoimmune diseases are often triggered by trauma and I'm pretty sure that brain surgery is traumatic!! If I did not have the brain surgery (and have the cyst removed) I would be dead - just like my sister died of the same problem. Even now 10 years after my Graves was diagnosed, I am not in any pain, but I am have difficulty managing my body because I keep getting prescribed drugs that are synthetic and not natural. Natural drugs dont make money for Big Pharma. And Big Pharma is ALL ABOUT making BIG MONEY!!! PS And yes I am a female. I agree with the last line abiove that says that "they" dont have the slightest idea whats going on." Because clearly they don't!! I also believe that some autoimmune diseases are inherited. My father also had Graves Disease but I did not learn this until after I got my own Diagnosis. His GD may have been triggered with his first cancer diagnosis - so he had to conted with both Graves AND cancer!! He died in 2016.
I got the exact opposite -- Hashimoto's -- from pregnancy. As did my cousin, though sadly her's kicked in mid-pregnancy and she miscarried. So as far as I'm concerned, focusing so much of the video on that was extremely unhelpful.
I'm thinking of all the women with auto-immune diseases that I know who also have kids, so I was surprised by the pregnancy theory. Two women with MS each had one kid, a woman with Graves who got her thyroid killed with radioactive iodine already had two kids, and a woman with RA and other struggles had 4 kids. Meanwhile I have autoimmune issues but no kids.
Fwizzybee 42 I’ve been on meds for my Graves for 6 years now. I showed up after I had my only child. And there looks to be no end in sight with my Graves 😢.
My autoimmune reaction stopped too, but five years later it came back and just wouldn't stop again. Got my thyroid out two years ago, best decision for me.
Gluten and my thyroid: exist
My immune system: *STOP! YOU'VE VIOLATED THE LAW!*
SAME
My niece is the same. She has Hashimoto's and gluten causes flares. I had Graves' at a young age, as did my mom. Thyroid issues run in our family.
as someone with lifelong autoimmune problems and now cancer, thank you for this video and all of the information in it.
I hope the best for you on whatever your course of treatment is. You got this!
Me too, autoimmune (lupus) & 2 primary cancers (breast, colon). The best explanation I’ve heard is by Gabor Mate, the body keeps the score.
Ive always wondered why most the women, including myself, in my family have lupus. Im so very thankful mine is mild but was immensely upset no boys in the family had it
Look into fasting. It has made such a difference with my own breathing, chronic BOOP, that I don't mind not eating near as often. I'm serious, look into it.
I fast 20 hours and eat within a 4 hour window and I can breathe much better.
@@franny5295 - Citations?
My dad has lupus, as do i. The thing is, when men do get it, it tends to be more severe. He had 5 near-deadly blood clots in just 2 years and had to get the filter implanted. Now it is attacking his kidneys. He was only diagnosed about 10 years ago.
I was diagnosed over 20 years ago and have not had major complications in all those years. I also have Crohns and other comorbidities, but my dad, by far, is sicker than me somehow.
Hank, as a Biochemist who studied immunology, I appreciate the amount of study you had to do for this episode.
My colon: * exists *
Immune system: Beware the ides of March
Immune system: Every day is the ides of March btw
My psoriasis first appeared when I moved countries as a child. It fluctuated over the years, but stress was a key factor in how bad it got. It would consistently worsen when I had exams, and got even worse in university.
My dermatologist was concerned the treatments weren’t working because I had a major stressor a week before almost every appointment. I had to show her mid treatment pics to prove that it had improved.
Once I took a break from university, reducing my stress and improving my sleep, my psoriasis immediately improved.
It’s now a game of figuring out how to minimise persistent stressors while living my life.
SO SAME. This illness is such a HELL, and an unknown one at that which is beyond infuriating!
My spouse has had severe psoriasis their entire life and what sucks is that if you were mega rich, you could very easily minimize the symptoms with medication. It's more profitable to let regular people suffer, I guess. :(
You are not only brilliant, but you bring your brilliance to us in a way that we can understand clearly.
It has been suggested that there is a relationship between autoimmune disorders, stress, and trauma. Trauma experiences in children disproportionately affect girls. I know 3 women with autoimmune disorders, two of which have at least two children, and one who has never been pregnant. However, they all share a history of high stress and trauma. It would be interesting to see studies on this possible connection.
There's been several. Stress activates your immune system. It makes any condition worse, and harder to treat.
Also, Hank mentioned doctors don't take women seriously. Having a doctor straight-up not believe you when you say you have this and this symptom, or assume you're overreacting about the severity, will delay treatment. If you tell a doctor you're stressed, they are more likely to assume your condition is psychosomatic, and stop looking further.
This might be bad news for me. I have a lot of stress lately, and I'm in a recurrence of an autoimmune blood condition... wonder if stress helped trigger it. Sure hope I don't develop any new ones.
@@LindaGailLamb.0808 I advise not stressing out about the possibility of stress triggering an autoimmune condition.
@@garethbaus5471 😖😜🤣🤣
Are you sure about that stat? Or are boys less likely to discuss these things?
From the boatload of women with Hashimoto's disease: thank you for making this episode. Nobody knows why we get sick, and it sucks! More science, pls!
Look up the work of Dr Gabor Mate and you might start to understand why
I think it's interesting they think lack of pregnancy causes it when most people (including myself) I know with autoimmune conditions has them pop up shortly AFTER pregnancy. It's pretty clearly induced by pregnancy itself. "rates" of autoimmune conditions of course appear to be going up cause a hundred years ago you were just "sickly", "hysterical" or "of frail constitution" or ya know just mysterious died which you see a lot of real and fictional women characters described as so it's always been common. The diagnosis and doctors taking it seriously is what's new and increasing
Yeah... our ancestors were a little busy not living past the age of 50 to focus on such things, you'll have to grant them a little lee-way.
I saw another comment from someone here explaining that they had some issues which seemed to lessen during pregnancy only to come back stronger and lead to a diagnosis shortly after the birth, and someone else saying their mom saw relief during pregnancies
Hank: “Our immune systems are amazing!”
My immune system: Huh? Nah.
Our immune systems are actually working overtime! It's crappy, but we gotta appreciate the effort. Unless you're on biologics, lol!
Look, it might not be getting the job done but dang is it trying!
@@somethingsomeone4359 It is definitely trying tbh 😭😭 you responded right as I’m fighting an awful sinus infection
I honestly canNOT thank you enough for making this much needed video! I have been disabled since I was born by a whole slew of autoimmune diseases. It's hard when you are very sick and grow up being told you're just "dramatic" or "lazy" or "useless." We NEED to talk more and more about these illnesses, especially when they are so often invisible and regular people don't think they exist to begin with! You and John are just the best, always striving to learn more and teach more ❤️
Very interesting information. I have an a.i. named ankylosing spondylitis. Along with osteoarthritis. Big , gentle, hugs for all autoimmune sufferers/warriors.
Fellow AS sufferer
I have AS too!
yes ive got this condition as well its one of the few that effects men more than women but is being diagnosed more in women these days yes big hugs and and stay strong to all autoimune sufferers
My dad just got diagnosed with this. His doctor said his kids likely have it, too. My sister and I have both had something ai since our mid 20s. The doctors never figured out what ours is. Just that it's something autoimmune. Maybe we have AS, too. Maybe the drs didn't look for it in us because we're female. It's pretty obvious on my x-ray, though. My dr told me my x-ray looked like that of someone 25 years older than I was at the time. It hasn't been fun. Yet I don't qualify for disability because I gave up on drs before getting a diagnosis.
@@virglibrsaglove I was undiagnosed for a long time yet had tell tale signs. It took an incident that caused severe debilitating pain and a new family doctor to put all the pieces together. Now I'm able to manage well enough to work and function thi not " normal" but works for me.
I wrote my college anatomy and physiology paper on this disparity and proposed to modern explanations based on research, and the conclusion I made is that estrogen is an inflammatory molecule. My auto immune disease symptoms got so much worse when I got onto a high hormone birth control, and I also successfully diagnosed myself with Addison's after that class 😂
I felt like hot 💩 when I was on high dose BC. The doctor basically said “no you don’t” and “well, it has nothing to do with your BC.”
I also have Hashimoto’s and was denied testing for years because it was the disease of the week in all the women’s magazines. It didn’t matter that my mom has it and my symptoms were identical. The first doc I asked halfheartedly poked my throat to check for a goiter (which is a symptom of an _overactive_ thyroid.) All of the docs involved were male.
A nurse practitioner prescribed me a lower dose of BC and it helped. I ended up on the lowest available dose and it was perfect. A different NP tested me for lupus and Hashimoto’s (she thought it sounded more like lupus but listened to me and tested for both.) Both of these NPs were female. I did have good experience with some male PA’s / NP’s though.
My takeaway: if the doctor brushes you off, find a NP or PA.
This is absolutely fascinating, particularly the bit at the end about pregnancy. My allergies all but disappeared after my pregnancies. I mean, I still have them, but they're seasonal and really minimal now. I used to have to take something like actifed pretty much nightly just to sleep.
I'm on my 2nd and still waiting for my allergies to regress even a little 🥲 How many babies do I have to have for this method to work?😂
@@frogosplayer1 Lol. I'm so sorry. I guess I just lucked out. I've had three of them, but the allergy decline started with the first. In fairness, my allergies have gotten a little bit more troublesome lately, so maybe they come back? I dunno. I also moved a couple hours south of my previous location so that could be a factor.
@@frogosplayer1 I had 3 children and I still have allergies and in fact, they got worse! I had pregnancy rhinitis so bad as well.
@@trishayamada807 😭 jeez that sucks!
@@frogosplayer1 I became allergic to metals as well after my first pregnancy. No surgical staples for me or earrings, etc. I always wanted a tattoo but I’m afraid now of an allergic reaction. I can’t use bandaids! What the heck! I wish my immune system would just chill out!
The sheer amount of information in this video, and my ability to actually understand it all despite doing very little with science, has awakened me to the true purpose of scishow. Thank you for slowly molding this world
When I was diagnosed back around 2007, one of the things a lot of women in the spoonnie community said was their symptoms or conditions (in this case fibromyalgia and RA) were less intense/went into "remission" during pregnancy. It'd be interesting to see the research around their experiential observations.
Pregnancy suppresses the immune system (probably to lessen the chance your body attacks the fetus). It seems logical this will lessen auto immune disease symptoms.
THANK YOU for acknowledging the gender disparity in healthcare. It’s so horrifically discouraging.
The weird twist to this is that today, men with several autoimmune conditions don't get diagnosed with the severe conditions until many years later. My doctors took 20 years to take my conditions seriously because they believed "only" women had the severe autoimmune disorders, because doctors tend to suck at interpreting stats. It took several organ failures for them to tie the dots over many years of disabling symptoms never being treated. They'd just focus on one thing for years and assume nothing else was related. There's very little education in autoimmune conditions as a whole, in my experience, both in treatment options as well as identifying or probing for comorbidities. It's a tremendous amount of needless suffering and waste of life waiting for someone to pay attention, in my biased opinion. Unfortunately there doesn't actually seem to be much research happening. Studies are very narrow to specific conditions and not much about overlapping ones to study similarities or history. Plus, of it takes 20 years to diagnose, a lot of people with conditions don't qualify for studies until 20 years later when they may be less capable of attending or carrying out studies they finally do qualify for. Then sample sizes are also tiny so they yield less certain results. Then there's the range of treatments for the range of symptoms all with their own ranges of side effects which need more data to factor out of the underlying correlatives further complicating analysis.
It's tragic its taken so long to get taken seriously, but with more exposure from episodes like this hopefully the next generation will have more will to devote resources to properly studying autoimmune conditions both in treatment and diagnosis. A lot of the long term damage could be mitigated by early detection and preventative lifestyle adjustments, but that has to start with the clinicians and schools awareness, I think. The obvious catch 22 being that can't happen without studies and studies can't happen without prompt diagnoses.
I found out I inherited my father’s Ankylosing Spondylitis 30 years after they checked my brother for it(negative). It was believed a “man’s disease” and women who have it finally diagnosed had to live in pain for years get treated incorrectly. I begged my Dr for blood test he agreed after my father died from AS complications. I was sadly correct.
Someone I know, a transgender male, didn't get diagnosed until after his transition. It's pretty bad after years of non-treatment. I'm sorry your father had to pass away for you to get diagnosed.
I really hope these things get solved. My Lovely has autoimmune. Her life in the past few years has been terrible to the point many doctors she sees don't know how to approach her. She had gone through many procedures, but nothing lasts for her. I constantly check up on her and ensure she is doing well. hopefully science can tackle these autoimmune issues soon.
Hope she gets some help soon!
In my family these are kinda common, even in the extended family (yay! genetics...) in spanish I came to know them as Catastrophic Diseases, even if they're not diseases but conditions. Important difference, my sister is super specific about it, because it changes the perspective of living it. I hope your lovely finds a doctor who finds an efective treatment, as far as we have lived it, that's what you can fight for, because these don't fade... but with a good treatment there might be a remision-like state, I'm trying to translate it from what our doctor explained because he's been great to make life livable for my family. We've found it, but even then there are ups and downs and the come-alongs can help them to navigate life with this, it has an efect in us too, but knowing about it helps us to help them to live a better life.
Look for help with naturopathic medicine
Odinkaar: Have you tried en.wikipedia.org/wiki/Helminthic_therapy
Research Intestinal Permeability. Supposedly its a possible cause of an overactive immune system. And it can be reversible.
Thank you for your sensitivity regarding discussing sex/gender/identity/organs. This needs to be normalized, IMHO, and I am grateful for your effort in realizing this.
I’ve had several male doctors ask me if I am anxious or unhappy in response to valid medical symptoms, only to find out I had several actual medical problems with my spine and with hormonal and metabolic issues. I never experienced this from a female doctor. In response to my comment that I read that male doctors often miss serious health problems in women, dismissing them as emotional problems, this male doctor responded with telling me he resented me thinking that. I told him that I resented him immediately asking me about my happiness and if I was depressed instead of trying to find the cause of my pain. He was the head of his department and received many accolades. He also treated my female friend the same way. I went to a female doctor and was finally diagnosed. So it is true that medical problems is not as well studied or taken as seriously in females, especially by male practitioners, and it is documented.
Well that's incredibly complicated. I think it's worth looking into emotional trauma and chronic stress. Women generally undergo a lot of that because of sexual assault, societal pressures, and how we’re treated. So do trans and intersex people. That could explain why those groups are disproportionately affected. Emotional trauma literally gave me a heart condition so 🤷♀️🏻 it definitely affects the body via cortisol
I think that is a result of cortisol (stress) induced immunosuppression, intestinal tight junction breakdown via cortisol receptors, and subsequent mass cloning and cytokine storm and reduced calciferol and retinol binding proteins.
Could be a result of mosaicism gone haywire too.
@@fragileomniscience7647 @crisptomato94 I will have to look that up!
Have you read, "when the body says no" by Gabor Mate md or "the myth of normal" by the same author? I 100 percent agree with what you said btw.
@@janinebean4276 Note however that cortisol/corticosteroids actually help tighten blood brain barrier tight junction protein complexes via some signaling mechanism I don't remember (but you have the keywords to look it up).
Maybe inflammation and latent infectuous reactivation are the main mechanisms. Maybe it is the inflammatory cytokines which signal towards hypothalamus receptors to downregulate cortisol feedback receptors.
I'm a Twin (identical) and I have Graves Disease (a stress induced autoimmune disease) but my sister hasn't developed it.
Lynn Rolaf maybe she handles stress better than you?
Most likely environmental and genes....still sucks
@@GodWorksOut Maybe she is exposed to less stress.
@@heatherdavis9525 that's the point about being a twin we actually started our existence as a single egg, and split into 2 separate embryos. That means SAME DNA. Yes, there are environmental factors, but we spent most of our lives in the same environment. But I think she does handle dress much better than I do.
@@lynnrolaf7422 "That means SAME DNA."
Nope. Not completely.
Even in your body cells of the same kind might have some differences in their DNA due to mutations that randomly occur and sometimes add up over several cell divisions.
Regarding sexism in medicine and how pervasive it still is today, I'm AFAB and it took more than a decade to be diagnosed with Ehlers-Danlos Syndrome- a genetic condition that means the collagen my body produces is defective. Because blood labs never told doctors specifically that I have this, even though the doctors watched my body deteriorate and my health become progressively worse, I was always treated like perhaps I'm a drug-addict that is doing this to get narcotics. Or maybe being 40lbs overweight was the problem. I was forced into a program to get gastric bypass surgery, and ultimately refused the surgery at the end, because that couldn't possibly fix what's wrong with me. I'm glad I didn't, because the chances of me healing properly from that are low. I never healed right from the gallbladder surgery I had, or my shoulder repair- why make it worse for myself?
There's a weird catch-22: if you're in enough pain to warrant narcotics, you're hysterical and addicted and clearly don't need it. But if you go in before it gets to that point and let them know what your problems are, clearly you're also not in need. Kidney stone? well you visit us more than twice a year, so you're clearly a drug-seeker. Whatever narrative you had in your head, my problems will be forced into that narrative until I'm a criminal of some kind.
My spinal cord : * exists *
My immune system : Get out.
Hank is the best person to talk about this for the people who don’t know hank has an auto immune called Ulcerative colitis Which is funny when you think about
(And especially since i got U.C. too)
For real? He already inspired me, but now he's even more awesome! I have UC too!
But you, Ahmed Toughan, are awesome too!
Hank has gone on the Crohn's Disease sub-reddit to talk with everyone about UC and Crohn's. I have Crohn's disease. Since us Crohnies and UCers often deal with a lot of the same crap (literally and figuratively lol). :)
Ahmed Toughan I have UC too! I didn’t know that Hank has it as well(!)
Wasn't thinking funny. Winced as a good friend has it. Brother may be developing, as well. Funny seems wrong word to apply, except you may intend odd as a better choice?
Andy Panda nah, funny seems like a perfect fit
As someone with Sjogrens I can assure you it affects more than just salivary and tear glands. :(
Duessa2000 Same! :(
Yep! Dry *everything* 😉
My mother has it, seems pretty horrifying
Have you experimented with different diets?
@@sacramentallyill you are that person that everyone hates. I suggest you watch the video on Hanks channel Vlogbrothers titled "your illness is not your fault"
I've had more children than most...4 kids (3 pregnancies). That didn't keep me from being diagnosed with Fibromyalgia 🤷♀️
Interesting stuff. I have an autoimmune diseases and almost all of my symptoms disappeared while I was pregnant. I had not been diagnosed at the time, which makes it even less likely to have been psychosomatic.
considering they use immune system suppression to treat autoimmune diseases and pregnancy naturally suppresses your immune system to prevent it from attacking the baby, that makes perfect sense
I end every day with the daily scishow video, wish me good sleep
Same. Night night.
I end it by binge watching these guys until I realize its 4 in the morning lol night
G'night sweat heart. I'll be watching you in your sleep.
Same, night mate
I usually watch them first thing in the morning, but tonight I was awake for too long and got to it early. Good night!
As a female with MS I couldn't help but click. I often wonder if they will discover the cause in my lifetime.
blackberrymidnight The cause is likely genetic mutations, likely several, in the upstream region of immune system related genes. These mutations change the expression of these genes, estrogen and other hormones women express in High amounts are responsible for expressing these which is why women are overrepresented. Unfortunately since mutated genes are inherited, and cannot be changed, yet, No complete Cure is likely to ever be invented other than bone marrow transplants which completely replace your immune system, better treatments will certainly come however. Hopefully this helps you!
@@kevinrein5623 how is it that rates of MS are higher in a geographic area then? (Alberta Canada) it has to be more then genetic, there could be environmental causes as well.
@@Hippyganster31 Yes, It is absolutely more than genetic, and as you say the increased rates in North America for autoimmune diseases put up a strong case to speculate these. It may be very well that certain environmental factors trigger certain autoimmune diseases depending on geographical area in patients who otherwise would've not developed the disease. I guess you could argue that is causal.
However it seems that genetic mutations is what makes patients susceptible to develop these diseases in the first place, many of these gene mutations have already been identified in different diseases already.
My godmother has MS, it can be bad. But she's in a lessened state, not having major exaserbations. However, while she is not Immuno compromised, we would consider her Immuno suppressed. Her immune system just kills everything. She thinks that it was possibly triggered by a measles(?) Vaccine. She then proceeded to walk out of the doctor's office she faceplanted and scraped up her whole body. Her entire body was scabbed up. Fun.
I've found limiting my exposure to nanoparticle diesel soot keeps my MS flareups at bay.
I have recently read doctor Gabor Mate's books. His theory on autoimmune diseases being overwhelmingly common in women is that, culturally, women are expected to take on the caregiver role, ignoring their own needs and repressing their emotions (choosing not to complain so as not to cause a commotion, not allowing oneself to feel anger even when it's warranted, not being assertive, etc.) The result, alongside a build-up of chronic stress, is a blurring of boundaries between oneself and others. Unable to distinguish between the two, the immune system turns on itself. Repression of emotions = repression of the immune system.
He noticed that people with autoimmune diseases all tended to have the same personality. Unable to say "no, I'm sorry, I'm too tired" to anyone, they would keep chugging along, mentally fine, until their body gave out and they were forced to finally put themselves first, but even then, many don't. These people often have had to repress their emotions in order to be accepted by mom and dad. This emotion repressing then (unintentionally) gets passed on to their own children, who learn to do the same.
It's a scary theory because, if true, you can bet we will never get the memo on this. Just look at this video. There's no place in science for subjective assessments like personality and childhood trauma. By the way, Mr. Mate doesn't actually believe that it's anyone's real personality. Being unable to say "no" to anyone is a sign that you're afraid to be your true self on some level. But people are often too disconnected from themselves to realize that.
Thank you for making me think of my autoimmune conditions differently. I hope that one day this will be fully understood, but right now you're doing so much to spread awareness already. Thanks dude. ❤️
I am surprised by the direction the comments went to. I am a 56 year old Male, born and raised male, diagnosed 3 years ago with an autoimmune disease. I am one of the lucky 25%. I been told that I am one in a million. Been led to believe that my DNA has been reprogrammed trigged by the ebsteen barr virus. Spent most of my life active and healthy until 8 years ago, health issues slowly came up as the disease morphed into what I have today. It is very difficult to have any doctor look at your test results and say you have a disorder if they have never seen it before, guys have always been told to "walk it off", and I tried. This is for real, it was trying to kill me. I was ill for years not knowing what was causing my health to deteriorate when a young female ER nurse pointed out what it could be. Treatment started soon after. I will be on immunosuppressants for for the rest of my life. I was hoping the comment section would be a little more constructive.
Thanks for sharing the info. Good job on ER nurse part in pointing it out for you. May i know what was the condition she pointed?
I have MMP unusual for middle age males. It is active in my mouth, sinus, larnex, and esophagus. blisters on head and neck when flairing, when blisters break they leave behind alot of scar tissue. Not much holding my teeth in anymore. Has not gone optical yet, I have that to look forward to if I don't get it under control. Its considered a sub epatheal blistering disorder. Short version... my immune system is attacking the glue that is holding me together.
@@daveschilling1575 That sounds scary. Thanks for taking time to explain your condition. The only reason i asked is for people who will read your comment know of if it ever happens to them so they can actively talk to doctor about that.
Lol you were expecting a TH-cam comment section to be more productive? Are you new to the internet? All things considered , this is one of the better TH-cam comment pages
@@jamesbizs still, just because something has always been corrupt doesn't justify it being so.
Thank you for addressing autoimmune diseases. I have Ulcerative colitis (apparently Hank does too?! I just found this out!) that really threw a wrench in my life my senior year of high school. It’s still an adjustment and I still grieve my old, healthy self. I also have endometriosis, hEDS and potentially Dysautonomia too.
I’m adopted so we really don’t know/have any familial medical history which adds even more complexity to my situation.
Invisible illnesses suck! I’m not any less sick just because I “look” normal. 🦓
U.C. , like crohn's isn't exactly autoimmune
Sumaiya Haque it isn’t 100% understood. Some research suggests it isn’t autoimmune but not enough to know for sure. For now, my care team (at Stanford Hospital) still considers it autoimmune.
Huh guess UC is way more common than i thought... Thats comforting
this condition can affect you if you have got ankylosing spondylitis which i have but i havent had UC
@@sumaiyahaque any condition that involves tissue being attacked by the body IS autoimmune, any condition that harms the gut also effects immunity. This is well known in anyone who knows about UC.
Transfemale here: From when I was young have had multiple periods in which I was pretty allergic to some things (causing itchy bumps on my skin for the most part, but still).
When I got older I became increasingly allergic (and this time it stayed like that, while earlier allergic responses tended to go away after a random time) for apples, and in the end I needed to stop eating apples (touching them caused blisters on my hands or swelling of my lips when just touching a part of an apple).
After apples I got allergic in the same way to pears, plums, peaches, nectarines and strawberries, and eventually got diagnosed with celiac's disease in 2011.
In 2018 I started female hormones and after about a month and a half I thought to try some of the earlier fruits I should've stayed well away from previously (it was because a wart on my hand that had already been scheduled to be burned with nitrogen because it was so big had vanished in that time period) and carefully tried an apple, and it went fine.
Same with pears (Conference pears are fine, another race of pears I forgot the name of are a little bit of a mixed experience, the response to it is a lot less fierce than it used to be) and strawberries stopped being a problem (not even a slight tingle anymore).
About a year after hormones I was preparing carrots and even though my hands itched I didn't really gave it much attention, until I started noticing how the knife used to clean the carrots felt like I could not grip it in the same way, and made the mistake of scratching the skin near one of my eyes, which after that quickly started to swell and proceeded to increase this until the swelling had closed that eye off and my other eye was quickly on it's way to go the same route.
I now know I need to be incredibly careful with raw carrots, potatoes (same response, blister-galore on the palms of my hands), farmer's cale and endive. When cooked and stuff: nothing to worry about, but raw: Ugh....
As for the celiac's disease: that one unfortunately did not go away, I got incredibly ill after eating at a restaurant which obviously made a huge cross-contamination mistake.
I don't know about allergies, I've never really had any, but I noticed my tastes in food have changed quite dramatically since getting on hormones.
Sup dude.
After pregancy, my body would flare so bad with psoriasis and psoriatic arthritis (after months of being symptom free with pregnancy). LOL, my Dermatologist remarked that I should just stay pregnant when I told her how I was in remission during this time. I always wondered why this wasn't looked into more. I know I'm not the only one where remission happens during pregnancy. It was such a nice break although nauseau was an issue for me.
I've heard the same in those with MS went into remission during pregnancy.
my rheumatoid arthritis, bad vision, tiredness, digestion problems and many more decided to stop, when I got progesterone injections as contaceptive.
Now doctors noticed some blood cotting problems, so I can't have progesterone anymore.... everything back to 'normal'. Honestly, I'm ready to die. This life is a cruel joke.
@@dabole6363 so sorryto hear this. I know that everyone is different but ten years ago I did a hardcore elimination diet and it was the best thing I ever did. I do wish my conditions would just disappear but I was able to get off meds. I was reacting to my meds and was too freaked out to try another one so decided this route and never looked back.
My mom worked with a lady whose autoimmune disease went into remission when she was pregnant. She had ten kids lol.
I've joked with my rheumatologists about this concept of being a walking baby maker and wouldn't need to worry about needing medication, could take on surrogacy as a profession for health reasons lol Unfortunately haven't been in the best spot financially to take on making babies lol 😅 so immunosuppressants it is
I remember a lecture back in my undergraduate studies about autoimmune disorders and type 1 diabetes. Here, the patient's own T cells start to kill insulin-producing beta cells. Since type 1 diabetes is so common the professor wanted us to remember all early symptoms in order to recognise if someone suffers from this disease (I'll plan to make a video about that myself to spread awareness!). So be aware if you know someone with increased thirst, extreme hunger, unintended weight loss or fatigue!
Type 1 is actually not that common. I have met less than 10 people ever who have had it. By far, most diabetics are Type 2.
Toni Castel it’s still common enough, and unfortunately misunderstood enough that lots of people misdiagnose type one diabetes. Many cases are mistaken as a flu and people die. Extremely important to spread awareness of the early signs!
SweetasSugar42 I agree completely.
That happened to my niece.
I've work with 2, at the same time, in a smallish workgroup ( less than 12) and have at least one quite close relative with type 1. 2 male 1 female
Thank you for responding to my multiple rants. My RA has taken me down, and I’m still in the “angry” phase - too angry to meaningfully participate in more patient-based lobbying. Autoimmunity is an epidemic and becoming more prevalent. We need an #autoimmunecure.
My grandma has had RA for almost 60 years. She calls it Arthur. It took me years to understand why she would say 'Arthur is angry today'. I'm sorry Arthur is angry right now. I hope it calms soon!
I’m still pissed off, and it’s been nearly 7 years since I was diagnosed. I used to go running, go to the gym, cycle and was a photographer. I can’t do any of that now. I often find myself having a bit of a cry, not being able to do photography anymore. Having everything you are and love, be taken away from you is extremely soul crushing.
Bluesmachine100 You can say that again and again and again and again and again....
@@bluesmachine1006 I'm sorry if this isn't really a solution to the health problem, but a suggestion on the photography part. If you can move your hands well enough, you could acquire a drone to do the locomotive parts, and you could in principle be driven to the locations of interest to be pictured. I am not claiming it'll be the same thing, but, it seems to me, it beats being saddened. I'd suggest starting on a small scale in terms of drone and camera to see if you like it first.
@@VeteranVandal Not a bad idea. Drones can take us to views we've never seen before. Lots of room for creativity. Still, just the pain alone can be so distracting as to kill any creativity one could muster. It seems so unfair.
I could cry. Thank you. I love hearing this information come from a man.
I really love the inclusivity of discussing autoimmune illnesses and their prevalence in trans and intersex people. Thank you.
One hypothesis that I've heard about autoimmunity is that autoimmune conditions occur more frequently in more "Western" civilizations today because we are less prone to hosting parasites. For eons, we have evolved alongside internal parasites, and we had to adapt somehow to be able to survive and not starve to death. The hypothesis is that some populations of people (those living in areas most likely to have parasites) developed over-active immune systems in order to kill off the parasites. Now, however, without any parasites to kill off, our immune systems start attacking ourselves instead. Perhaps it was even more important for women specifically to have over-active immune systems because if they didn't attack the parasites, their fetuses would be under-developed and not survive to adulthood.
That's an interesting hypothesis. One thing comes to mind, though: we might want to remember that non-"Western" populations are seriously understudied in just about every branch of academia and every aspect of their lives. Can we really reliably claim that they have significantly fewer autoimmune diseases than Europeans and their post-colonial descendants?
This is called the hygiene hypothesis
You make more sense than the lack of pregnancy conclusion. That's just ludicrous
more than hosting parasites, we are way more likely to host pathogens instead of friendly flora due to the overuse of antibiotics wich kills friendly flora fast and pathogens resist it. we also heredate all of this from our parents. specially your mother.
@@weareallbornmad410 You have a good point. These populations need to be studied more in-depth as well.
The theory that pregnancy is a possible tie to autoimmune disorders is incredibly interesting, especially considering that my autoimmune illness was triggered by my pregnancy (however I was hereditaryly predisposed to what I have anyway, which coincidentally only occurs in the women on my mothers side of the family)
My money is on stress and emotional trauma being a massive factor too, which may also be a factor in why women have it worse; in most places high stress is the norm for women. My anecdotal observations are that transwomen also get a lot of stress while I've heard less accounts of such from transmen, and I'd wager being intersex can be a world of stress in and of itself. In my own experiences with auto immune conditions, they always get worse when I am in a state of prolonged high stress (I have several, they all gang up on me more when I'm more stressed - to make bad situations worse).
That's not to say that men don't have stress, but as far as I'm aware men don't have to look at a strange women and have their mind automatically attempt to calculate if she is likely to try to end him (or the other terrible thing, which for women is on about the same threat level given all the complications and implications that go with it). I don't know about trans women, particularly concerning that other terrible thing, but I know cis women automatically make this calculation every time she is in an environment with strange men, even if its only a background thought that passes so quickly she's not really consciously aware of it because the odds calculated are low. However, it gets much worse if the odds calculated are unclear or too high for safety as then. assuming she can't/wont just leave, she's on guard constantly - in a state of constant stress - as she constantly monitors the situation (also applies to recreational situations like clubs, pubs, bars, restaurants, ect - she may want to let off steam and socialise, but she will still be in some level of constant stress).When men make threat assessments, its usually, in my observations, mostly concerning other men, which reduces the population he has to monitor by 50% (situation depending) on top of which, a man is far more likely to be able to defend himself or at least run away from another man - it's not so "easy" for women. To put it in perspective for any men reading this who hasn't considered this before, for many women living with men is like living with wolves; if they are your friends and true family (as opposed to abusive family) then they are wonderful, supportive, protective, but if they are not then being in the vicinity of one leaves you constantly aware that if it turns on you, you could well be dead, and that awareness never goes away until real trust is earned.
Popping in to add that trans guys deffo have as ton of stress too. And we disproportionately have more autoimmune conditions compared to cis men. Even looking at our population through the lense of the auto immune hormone-link theory, I think this still stands, as most of us still don't get the chance to start HRT until we're well into adulthood.
There's also a correlation between mental health conditions and autoimmunity. Perhaps stress triggers both mental health conditions and autoimmunity in the same people. Stress tends to contribute to disease flares, too.
right? they haven't even mention it and it was the first thing on my mind. or if they did I haven't heard it..
Immunologists, maybe: “You have Crohn’s because you only had one child.”
Me: “My uterus tried to kill me though.”
Science: 🤷
I took a basic immunology course in college. It was sooo convoluted that I longed for the days of organic chemistry.
My immune system attacked my son and just about killed both of us. I now have three different autoimmune diseases
Angela J My mom had the same experience with her second (and last) pregnancy. (Mom and sister are fine!) pregnancy doesn’t always help
I had a harder time with my son. I thought it was just the chromosomes, but he was the second pregnancy...
@@jacquiz.6837 It MIGHT be that second pregnancy is read as an invasion. I had issues with my second that I didn't have with my first and I was already immune challenged...
So glad all is well!
Hemolytic disease of the newborn:
en.m.wikipedia.org/wiki/Hemolytic_disease_of_the_newborn
@@AveryMilieu first pregnancies and the delivery of the child are often the point at which the mom's body receives the signal that there is a foreign invader (baby), and the second pregnancy is when the mom's body attacks. Are you RH negative?
Honestly you are right on. Women's health is definitely underlooked and not taking that seriously.
Thanks so much you guys for tackling this topic! As someone who is suffering from an autoimmunity... it always brings hope that one day this will be figured out.... because it really REALLY freaking sucks!
Human w/ uterus: “haha i don’t really want to produce a child right now, it wouldn’t be beneficial and can be very dangerous!”
Uterus, who has not only now conscripted the entire immune system as well as a large portion of the endocrine, musculoskeletal, and hematological systems to do its evil bidding, but is also polishing a knife with a look of sheer brokenness in its dead eyes:
“Say sike right now”
I'd take autoimmune over a thing growing in my body
You mean I shouldn’t have been responsible? :(
That’s why my body hates me?
He talked about trans women
@@molchmolchmolchmolch It's not just a thing, at least not once it's real and you're ready. For a whole lot of moms, that's their heart on legs. It can be the most beautiful 'thing' you can create, if you let it be.
@@FroehligGirlz Sure could be! But high costs of living, increasing academic pressures, job instability, over population and uncertainty may mean its not ideal an environment the little ones.
My connective tissue: *exists*
My thyroid: *exists*
My immune system: *screeching in the background*
I just want to say that I found this video to be insanely interesting. I'm a medical laboratory technician (run lab tests on medical samples; sodium levels to tumor markers to pregnancy tests to molecular diagnostics & more), & I absolutely love detailed info relating to genetics & possible effects of different genes/variations.
I love your videos. Please keep 'em coming!
I'd never thought about it specifically, but I have celiac, and I definitely should have noticed at some point that of the five people in my family who have celiac, I am the only male.
It was very entertaining to, as a Swede, hear Hank pronounce Sjögren xD
I’ve been waiting for something like this. My mother has three autoimmune diseases and it’s drastically affected her life, to the point where she can’t even go out in the sun for more than 30 minutes at a time.
My mother isn't well suited to sunlight either but I think it is just because she is really pale.
Gareth Baus it’s not so much that my mother’s pale (even though she is). One of the three diseases is lupus and going out in the sun causes it to flare up horribly.
@@abigrace5998 I was talking about my mother with the being pale part, I figured you were talking about the effects of sunlight on the immune system.
Trauma specialists and researchers have been finding high rates of chronic illness correlating to high rates of prolonged stress, especially if that stress persisted throughout the formative years of childhood and adolescence. Complex PTSD also frequently features in people with damaged immune systems, formed from enduring prolonged and inescapable adverse conditions, whether physical, psychological or any combination of influencing factors. Adverse conditions, such as having to remain vigilant against sexual assault, as vast numbers of little girls must do daily, wears your body down, affecting your ability to rest, sleep, heal, eat and digest food (and gain nutrients), pass waste materials from the body, and to control (and specifically end) the release of stress hormones like adrenaline and cortisol.
Prolonged physical pain can also weaken your immune system too, and there's increasing studies on the massive numbers of girls and women who suffer crippling pain from their menstrual cycles every month, which most girls get trained out of ever mentioning to anyone, and most doctors are quick to dismiss as being a serious medical problem that requires investigation. Bessel Van Der Kolk's 'The Body Keeps The Score' discusses this a bit, but there are also plenty of academic papers accessible on Z Library for people to read up on this, if you want to dig deeper, which for any chronic autoimmune sufferers like me out there, I thoroughly recommend.
Division of household labour is also a factor: i.e. if you grew up in a culture where children's chores were divided by gender, girls were often given the chemicals and particulates jobs: being frequently exposed to and breathing in abrasive cleaning chemicals like surface sprays, bleaches and caustic laundry powders, dust and fibers from laundries and sweeping/vacuuming, ash and smoke from fire places and cooking, etc, which gets into the lungs and does severe accumulative damage over time. The culture of gendered labour and girls doing the household chores also meant that for centuries women could not physically rest and recover at the end of each day, unlike working men who returned home and could sit down and stop, women were expected to keep cooking, cleaning, washing, tidying, mending, raising the children etc for as long as they physically could each day, which contributes to chronic exhaustion and puts further stress on the body's already struggling systems.
Then there's the whole slew of psychological attacks, such as being belittled, gaslit, told you're weak and stupid and not worth as much as a man, that millions of women endure not only from infancy and childhood but throughout their entire lives, that psychologists are now beginning to study in much greater detail, having decades of accumulated research to draw on as they track people throughout their lives.
In summary, it's a rich tapestry of cultural, physical and lifestyle factors and experiences that wear a person down, mentally and physically, over the decades of their life, resulting in damaged and depleted immune systems, and a whole host of chronic inflammation, chronic pain and chronic illnesses and disorders result that we are just starting to take serious notice of today.
I used to boast how I never got sick and I had a really strong immune system, but then it decided to commit mutiny and I was diagnosed with RA at 25 lol. It is something genetic, runs in my dad's side of the family, he was diagnosed a few years after me. My great grandparents had it and so did my grandmother. Super fun, though luckily I have it under control currently, haven't flared since my diagnosis.
None of my autoimmune conditions are RA but I definitely was the one who never got sick. Even now, I never catch colds or the flu or anything contagious (possibly because I've been so careful with germs since COVID started), all my sick days are from autoimmune flare ups.
My Hashimoto's disease is definitely something that runs in my family. Both my grandmothers have/had mild cases, my mother has a mild case, her grandmother had a more severe case. I got the bad genes from both sides and also developed a more severe case.
I also have Addison's disease, that came out of nowhere. I have a great diet if I have to say so myself, my lifestyle has never been bad. I sleep better than most people. It just happened.
I would love to know how it works after loosing my entire colon to ulcerative colitis at 13 years old....20 years ago and still don’t have any answers
What would you like to know? It’s not fully understood, despite the fact it’s rather common.
Basically you have lymphocytes that shouldn’t be where they are. They’re T-cells.
At least that’s what we think. Like I said, sadly we don’t definitively know.
Studies have also shown a possible genetic trait.
But I’ll try to answer any questions you have to the best of my ability.
I’m a final year med student, I should be a doctor in about 2-3 months.
It’s not my speciality, but I still know quite a bit about it, I like to think.
Gregory Malchuk I got sick when I was 11 and they tried everything to treat it, nothing worked and my colon ruptured, my surgeon was amazing and saved my life x
Nihilistic Atheist we have gone through the entire family history on both sides and know it’s not genetic and I’m still the only one who got it, I have the j pouch now and living ok, wish I had a better diet but I work long hours so have to make do x
Wilderness Bath Crafts the similar thing happened to me when I was 21 except I have crohns. My colon was the worst off. I had been in a flare up for a while and nothing was making it better. Colon perforated in two places and the surgeons decided to take the entire thing. I have a permanent ileostomy now. Stay strong girl.
HeyHay oh no! Hope you are doing well, I only had the bag for 6 years before the reconnection, it’s not nice xx
You can have more than one auto-immunity as well. My sister had Crohn's and then developed both MS and Lupus as the first one advanced. I have Hashimotos Thyroiditis, MS, and Fibromyalgia with Chronic Fatigue. The thought here is that it has a great deal of reactions to stress. When your body goes on high alert, things break. Or trigger. Another possible in my own case was a bad encounter with anhydrous ammonia when I was about 8. My father was fertilizing a field and didn't see me around it. I got a good face full and it was horrible. While I recovered, it was later on when I found out about the MS (age 26) and thyroid was when I was 38. The MS is the relapsing/remitting kind and has been pretty much in remission since I was 30. Fibro came into play when I was in my mid 40s. I have a couple of great docs who deal with this mess. I was fine dealing with the fibro only (and thyroid is medicated) until 2 years ago. It is suspected that the MS return was partially due to the covid vaccination putting stress on my body. I had 3 shots and got worse each time. The doc is still working on this part.
So, this was an interesting video, thanks for doing it.
Thanks for sharing my MS also got worse after I got the covid shot. Interesting how they keep pushing it because you can get a bad flare from covid if your unvaccinated supposedly. Damned if you do damned if you dont i guess.
I'm a woman and I got sick at 18. I had so many doctors tell me that I was making up my illness and it was all in my head. Doctors refused to listen to me. Thankfully, I found a doctor who believed me and sent me to UCLA when I was 30. Ends up I have a rare autoimmune disorder called Systemic Scleroderma sine Scleroderma. It took years, but during this process, we also found out I have Achalasia, Gastroparesis, Celiac Disease, Hypothyroidism, and Hypoglycemia. So it wasn't "all in my head".
Can I just say how much I love how these videos reflect the fact that science is a process and involves conflicting theories and updating consensus? It's nice that these videos rarely come to a single conclusion.
I have Hashimoto's and a fibro variant: I don't have the overall pain, but, boy, do I have tender points!
I have Hashimoto's also, I was never told it is autoimmune.
@Joan Hoffman Yup. Hashi’s here too, but no fibro, thank goodness. Even without fibro, my body still feels like blecch. I take thyroid hormones to, like, not die (myxedema coma), But beyond that...meh.
Oh, to be 20 years younger and have a normally functioning thyroid. ☹️
@@GrumpyOldFart2 -And to not feel like I'm freezing when the temp.s are below 60F.
I was happy that I actually sat down and read a book the other day, until I noticed that my fingernails were turning blue on the hand holding the book. My hands and feet freeze if I'm not moving them.
Yep hashi here too! Not fun. Hard to find a Dr who will prescribe dessicated thyroid medication.
This is a fantastically orchestrated video, very informative and due to the amount of explanation and visuals it's easy to digest despite the huge amount of info. Thank you SciShow 😊 Loved learning this stuff! Very interesting
also huge props to how folks at scishow presented the gender stuff, y’all handled it really well. as a nonbinary viewer, it’s so refreshing to see people put that much care into the complexities of the issues
Thanks for commenting. Not nonbinary but totally agree this was so well handled, inclusive and respectful. I am going to recommend watching this video as a gold standard example to others.
My irises: *exist*
My immune system: "ain't enough room in this body for the both of us pal"
Yay, uveitis! Love the flares when the irises go all clover shaped!
Jesus Chicken Christ I just googled that and I have to say it's equal parts terrifying and fascinating!
It’s a sad fact that once you develop an autoimmune disorder you will get more, I have FOUR! Not a lot they can do, you just have to learn to manage the symptoms. It is really becoming common these days which is weird. Thanks for the info.
Somehow I imagine no single factor can account for all these differences. Childbearing biology would for sure make one potential culprit, since it's directly related to a "foreign" thing forming in the body.
The skewing is also very interesting, and I feel like it could be one likely cause but maybe also an effect, in the case that the body systematically treats the minority gene as foreign and somehow suppresses its expression this way.
The immune system is wild and crazy complicated. This might be one of those things that will never be fully solved.
Thank you for all the videos! Please keep your amazing work ❤️
Thanks so much for this! I've been wondering why so many of the people around me in the trans community have autoimmune disorders, and while this doesn't answer that question, it's good to know that it's been recognised as a valid question.
Do you think maybe it's from estrogen treatment? Or maybe their hormone levels are naturally more female.
@@virglibrsaglove one of the sources linked in the dooblydoo says it's partially explained by lower testosterone levels (i.e. trans women who are taking an antiandrogen medication or who have had an orchiectomy are at increased risk) but also says that's it's more complicated than that and they don't fully understand it yet.
Interesting. As someone with autoimmunity myself my heart goes out to them.
To be honest, I have a feeling it has a lot to do with stress. My mother, sister and I all have Crohn's and it was triggered by traumatic event if our life for each of us. I'm the only transgender person out of us three but then again my Crohn's was triggered after my body had a growth spurt and I was feeling extremely miserable at the time without understanding I was experiencing gender dysphoria.
Being transgender is incredibly stressful in many way, from having to go through the wrong puberty to being targetted by hate crimes more and more. At least stress would explain why the disorders get triggered. At least I feel it has more to do with that than trans people being more biologically predisposed to autoimmune disorders. Of course that's just a guess from personal experience.
@@ZoyaStreet I found this association out just a week ago in the ulcerative colitis subreddit! Which also reminded me of a trans masc person who said how starting testosterone made them start recovering somewhat from a different autoimmune condition.
This was one of the most fascinating sci show videos I've seen in a while! Thanks for covering this! I have vitiligo, which is considered an autoimmune disease. I've been told that my chances of getting another autoimmune disease (like rheumatoid arthritis or a thyroid disorder) are higher. I've been lowkey paranoid about the arthritis especially because if I lost the ability to knit, I think I'd lose the will to live. I had apl leukemia when I was 29 yrs old (now in remission) and since I had to have a bone marrow biopsy sent off to see if I was in remission on a chromosomal level, they also noticed a extra copy of RUNX-1 on about 10% of my cells- something that "suggests trisomy 8". I didn't have any physical or developmental abnormalities (aside from apparently not talking at as early an age as most children do, according to my mom). I wish I'd gone into immunology or a field studying genetics - this is all very interesting to me!
Hey! I'm crossing my fingers for you that you don't develop RA but if the worst happens I've had it for 12 years and could maybe help with any concerns! It sucks but it won't end you.
I have vitiligo too (along with a debilitating neuroimmune disorder called ME) and my specialist put a note in my file to watch for type 1 diabetes as well the ones you mentioned. Just in case you ever start getting those symptoms, but I'm even more at risk because my maternal grandmother was T1D
Even if you get RA, you can still knit! I was diagnosed with RA 2 years ago, and I can still knit. I may not be able to knit for as long, but I'm just happy I can still enjoy my hobbies. Hopefully you never get it, it isn't fun
You have a lower risk of skin cancer - possibly because you already *had* a little bit of skin cancer that was caught in time. We don’t know if that is why people have vitiligo but we do know that their skin cancer risk is lower.
@@peterfireflylund interesting! I just looked that up - I'd never heard about my risk for skin cancer perhaps being less. My oncologist told me that I have an increased risk for blood cancer again in general because I've already had leukemia. I don't believe I've ever had SKIN cancer though before. I'm a little confused by that part of your comment. What do you mean by "you already had a little bit of skin cancer that was caught in time"?
One thing that we're really only understanding recently is that childhood ab*se can cause you to develop autoimmune diseases later in life. Sadly, girls tend to suffer the majority of childhood ab*use, and this can go some way to explaining the gap.