The 5Rs: Replace: diet and autoimmunity

There are a variety of diets proposed for people suffering with autoimmune symptoms. Just as diet is a perpetually proliferating topic, it will remain the subject of ongoing fascination and exploration, so the list of proposed diets may continue to expand. Yet there are two principles that consistently net out from leaders in the field of functional medicine and nutrition in recent decades, which reach across all of these diets to an anti-inflammatory dietary approach overall:

1. The right array and diversity of foods for anyone is highly individual. Moreover, that can change in time for the same individual, as biodynamics and stressors change.
2. There are common denominators that are inflammatory to most every body. Just like there are common denominators to the factors that drive autoimmunity itself, there are certain known foods that exacerbate the system, and should be removed and replaced with healthier, more nutrient-dense options.

It can be tempting to think that diet has nothing to do with your autoimmune condition — especially if it’s not one that is expressed directly through the gut, like IBD — but is expressed primarily through another part of the body, e.g. the joints, as in RA. This misunderstanding can be further exasperated by the fact that conventional physicians don’t often put stock in the role of diet in managing health themselves. It’s not part of their medical training in conventional med school. Even gastroenterologists get little training about the role of food in the body’s health system – and their whole specialty is focused on digestive health. Yet diet is arguably the most important lever you can pull in managing autoimmunity. Changes in diet can have significant impact in reducing inflammation and improving quality of life.

What do we mean by “diet”?

When we talk about diet, we’re not talking about weight loss or weight gain, although arriving at your optimal weight is often an outcome of eating well. What we mean by “diet” is the choices of the foods you eat. Diet is one of two major areas within your control that affect how your body responds to autoimmunity. You can’t change your DNA and, in many ways, you can’t change what life throws at you — but you can change how you respond to both. Diet, including nutritional supplementation, and lifestyle comprise these opportunities. While AI remains a multi-factorial disease — and so multiple tactics are most effective in combination — of the two areas of response you can choose, diet is arguably the most important lever you can pull to change the machinery of autoimmune function in your body.

Dr. Mark Hyman, a leader in functional medicine, describes the importance of diet with regard to inflammation:

“In my practice, treating food allergies and improving nutrition in general is the single most powerful tool I have to treat, reverse, and even cure hundreds of diseases that conventional medicine fails at miserably. These include allergies, arthritis, autoimmune diseases, fatigue, sinus problems, hormonal disorders, obesity, high blood pressure, cholesterol, digestive diseases like irritable bowel syndrome, reflux, and colitis, and even mood disorders like depression and anxiety — just to name a few. You see, we are seeing an epidemic of inflammatory diseases.  In fact nearly every modern disease — everything from autoimmune diseases, heart disease, and cancer to obesity, diabetes, and dementia — is caused by inflammation!”(1, emphasis added)

Inflammation is what autoimmunity is all about. At the end of the day, what you “remove” in the 5R approach, and what you “replace” it with, is selected based upon its contribution to inflammation or its anti-inflammatory value, respectively. Dr. Hyman again:

“Inflammation is part of the body’s natural defense system. When your body senses foreign invaders, a specific cascade of events is set off in which your white blood cells and some special chemicals called cytokines mobilize to protect you.

This normal type of inflammation is a good thing. It helps your body protect and heal itself.  However, when your immune system shifts out of balance, inflammation can run rampant — causing a chronic, smoldering fire inside your body that contributes to disease and weight gain.

The causes of this type of inflammation are all around you.  The sugar you eat, high doses of the wrong oils and fats in your diet, hidden food allergens, lack of exercise, chronic stress, and hidden infections all trigger a raging, unseen inflammation deep in your cells and tissues. And this inflammation leads to every one of the major chronic diseases of aging — heart disease, cancer, diabetes, dementia, and more.” (1)

So, what do we do about it? Dr. Hyman goes on to say:

“Consuming a low-allergy diet for just 1 week will help you eliminate the excess swelling and fluid that accumulates in your tissues from food-induced chronic inflammation. Despite criticisms you may have heard about losing ONLY water weight, this is essential for your body to begin to heal and detoxify.”(1)

Yet for people with chronic illness like autoimmune disease, it’s about more than just eliminating food allergens. It’s about choosing foods that either don’t cause inflammation, or actively calm inflammation. You’re going for a sustained, long-term impact.

As Dr. Sarah Ballantyne, the scientist behind The Paleo Mom and noted researcher and communicator on The Paleo Autoimmune Protocol notes:

“Inflammation is a factor in all chronic illnesses, and this is one area where the foods we eat can make a huge difference.”(2)

The answer to that question is, It Depends. There are potentially as many answers to that question as there are diets – not because a wide range of diets are good options but, rather, because the answer is individual within the world of anti-inflammatory diet options. There are common elements and then, beyond that, what works for you may not work for me, and vice versa. The end game is to get to the most widely diverse diet you can without triggering symptoms.

Some people can identify that array of tolerable foods simply, by eliminating the “Top 5” biggest offenders on the list of inflammatory foods, and then going from there. Others need to approach it more systematically. Still others need to follow a set diet to make it manageable, by accessing a supplied menu, shopping list, and even delivery service (I’m in this category). Or a combination of these approaches can work. But the bottom line is: if you’re not experiencing symptoms and your labs come back clean, eat on. If not, read on.

In my view, there are three ways to step into a diet that supports autoimmune wellness. These are listed in order of increasing complexity and effectiveness:

1. replace foods that are universally recognized as inflammatory foods with foods that are nutritionally dense;
2. replace a standard diet with a dietary framework that is anti-inflammatory as a whole; or
3. do an elimination diet and reintroduction protocol, such as the Paleo Autoimmune Protocol (AIP), in order to clear AI symptoms, and then achieve an understanding of individual tolerance of foods that are systematically reintroduced.

You may note by my certification as an AIP Certified Coach where my opinion lies as to what’s the most effective. In fact, a recent study proved its efficacy (3) in improving clinical response to IBD. Yet we live in the real world and, as a family, many of us land squarely in a hybrid space of options 1 & 2 above. For our family as a whole, for example, that approach gains us a high quality of life in terms of disease remission, convenience, freedom, flexibility, and a lack of a sense of deprivation – all of which are important criteria for our family and the ages and activity levels of our family members. So that works for us for now. That may change and, it’s important to note, it also matters at what stage of severity a person is with their AI as to what is the most appropriate approach. Increasing numbers of people who struggle to get a handle on AI are seeing marked improvement in their symptoms when following the AIP dietary protocol.(4)

To look at the three ways to step into a supportive, anti-inflammatory diet one, see “Stepping into an anti-inflammatory diet.”

Citations

(1) Dr. Mark Hyman, blog post, “Inflammation: How to Cool the Fire Inside You That’s Making You Fat and Diseased.”
(2) Dr. Sarah Ballantyne, The Paleo Mom, “The Autoimmune Protocol.”
(3)Konijeti, Gauree G. MD, MPH, et al, Inflammatory Bowel Diseases, Official Journal of the Crohn’s and Colitis Foundation, “Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease,” November 2017.
(4) There are a variety of sites and blogs where you can find testimonies of success in following the AIP dietary protocol; one such place is “AIP Stories of Recovery” on AutoimmuneWellness.com.