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Stepping into an anti-inflammatory diet

Joy Cutrone, Wellness & Certified AIP Coach, FMCHC-Candidate
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Integrating a healing diet into your lifestyle

Some people dive right into changing up diet — either because they’re that keen and adaptable, or because changing up foods has become a way of life in seeking solutions, or because they’re that ill and ready for a solution NOW. Other people need to tackle the change over time, to avoid overwhelm. There’s more than one way to make lasting change. Here are some options for stepping into an anti-inflammatory diet. Choose the one that’s right for you — and consider a program to get started, or a personal relationship with a coach or nutritionist who can help you succeed.

Option 1: Replace inflammatory foods with nutritionally dense foods

We remove inflammatory foods in the “Remove” step of the 5Rs process. The Top 5 inflammatory foods are:

  • gluten
  • sugar
  • cow’s milk dairy
  • bad oils
  • legumes (mostly peanut and soy).

Corn/other grains, alcohol, and sodium can be added to that list, as can be any foods that are loaded with toxins from the use of pesticides and herbicides.

So when taking this approach toward an anti-inflammatory diet, you remove those foods. Then, it’s important to note that what you take OUT can be substituted with what you put IN, which can go a long way toward making dietary change manageable. Note, for example, that, you might replace a dairy milk with a nut or coconut milk. Or you may use a dense vegetable, such as an eggplant, to replace a pasta in a casserole. Another great resource for identifying produce to focus upon is the Environmental Working Group’s Clean Fifteen, which counterbalance their analysis of the Dirty Dozen.(1)

This can be a place to start if you’re intimidated by a universal change to your approach to eating. For example, replace:

  • Gluten-containing foods -> replace with non-gluten foods, such as clean meats, vegetables and fruits, and paleo baked goods (these are grain-free; check for nuts if you suspect a nut allergy).
  • Sugar -> replace with honey or real maple syrup.
  • Cow’s milk dairy -> replace with coconut milk and coconut cream (where coconut is not actually a nut) or nut milks such as almond milk if you can tolerate nuts (gum-free milks are best). Grass-fed butter is also grain-free; ghee is free of milk solids, and is also generally tolerated in people who have difficulty with dairy.
  • Fried foods -> replace with broiled, steams, or grilled foods, and health-promoting oils such as coconut MCT oil like “Brain Octane” (tasteless and easily added to smoothies and hot drinks), and healthy omegas such as evening primrose oil, clean fish oil, and cold-pressed extra virgin olive oil for cold foods.
  • Legumes -> replace with clean vegetables and organic animal-based proteins.
  • Grain-raised meats -> replace with grass-fed meats when going grain-free.
  • Alcohol -> use in moderation (generally a good guideline anyway).
  • High sodium foods -> replace with Himalayan pink or sea salt to taste, in foods you cook and, therefore, can curate yourself.

Here’s a day’s protocol that you can do right now: Amy Myer’s “3 Meals to Fight Inflammation”(2). Note that these recipes do include nuts and seeds, which should be eliminated for someone in an active flare or who cannot tolerate them.

There are a gazillion recipes in the Paleo and AIP communities that are both delicious and anti-inflammatory. You can also learn more about these and other substitutions in separate articles on the topic. Note that, when you access these recipes and, thereby, let others who have worked through it to provide some guidance, you’re on your way to Option 2: Replacing a standard diet with a framework that can help.

Option 2: Replace a standard diet with an anti-inflammatory dietary framework

Anti-inflammatory diet options: Wow. This is a BIG topic. And your FxM practitioner or nutritionist may have their own opinion. We’re going to touch on the highlights here of select diets with an overall approach. There’s a great deal more information you can read online (see Resources or search on each diet’s title for more information).

Again, this becomes a personal choice and journey, some of which is informed by what your or your loved one’s individual needs are, what resonates with you, and what is a more manageable change. For example, our family includes young adult children and we all live busy lives. We have found, at the end of the day, that while we found it quite valuable to learn certain PRINCIPLES about anti-inflammatory dietary eating, we are deeply grateful that there’s a mainstream dietary way of eating that’s got it all put together for us. Thank goodness because, for people like me who are working in several areas and trying to figure out not just diet but the whole big picture, I’m deeply grateful that there is a protocol that’s put all of the ingredients together for me in recipes already: that’s ACTIONABLE.

For us, that’s the Paleo diet (3). All of the big inflammatory antagonists are absent from these recipes and yet, you don’t think about what’s NOT in the meals; you think about the deliciousness that IS in the meals. The Paleo diet emphasizes clean vegetables and meats and is one of, if not the, top diet for people with autoimmunity (4):

“The paleo diet is named for its basis in eating as our ancestors did—meats, fish, poultry, vegetables, fruits, nuts, and seeds. A paleo diet eliminates refined and processed foods, as well as sugar, legumes and all grains (including gluten-free grains). It is automatically a rather low carbohydrate diet and organic options are preferred.” – Robb Wolf, author of The Paleo Solution

For people with active inflammation, the Paleo Autoimmune Protocol or AIP (5), is a further filter on the Paleo diet. In addition to the Paleo basis, the AIP also excludes eggs, nightshades (predominantly tomatoes and peppers), nuts and seeds, and select spices. The AIP is first an elimination diet that then adds back foods systematically once symptoms have subsided, so you can see which foods you can ultimately tolerate without symptoms. Read more about the AIP in Option 3, below.

The Wahls Diet is another dietary approach that is a further iteration of the Paleo diet. The Wahls (6) diets is named for physician Terry Wahls who contracted MS, underwent conventional treatment and, not having made progress, developed a diet similar to Paleo and GAPS, but which puts an even greater emphasis on vegetables to ensure proper nutrition of the mytochondria related to MS. Note that MS has been identified as an autoimmune disorder.

There is also the Specific Carbohydrate Diet or SCD (7) diet, which restricts selected starches, fruits, and vegetables (carbohydrates) to aid digestion. Many people have found it to be helpful for digestive disorders in particular. It was groundbreaking when it was first developed. The GAPS diet (8) has evolved from the SCD diet, and focuses on helping the gut to calm and heal. GAPS stands for Gut and Psychology Syndrome and, as its name implies, takes into account more of a whole-person view.

Another option is a low FODMAP diet (9). FODMAPS are fermentable carbs, and they can be troubling to some people, especially those with digestive disorders. Here you also learn about specific foods vs. food categories, which can be less intuitive to manage but, like the SCD approach, they provide a specific map to follow.

Elaine Laird of Phoenix Helix, who has done a lot of work on diet to recover her own health in the face of RA, and who made many years’ progress and continues to inspire others despite needing to add pharmaceuticals to her regimen in 2017, does a comparison of GAPS, Paleo and Wahls diets (10). Mickey Trescott also does an analysis of the AIP vs. other healing diets.(11) or see our own Diet Matrix to compare them all.

There are other anti-inflammatory diets out there if you search, including a food pyramid by Dr. Weil (remember Dr. Weil, before all the ads and vitamin promotions?). Dr. Weil’s anti-inflammatory diet includes dairy, legumes and grains that have since been found to be inflammatory in studies and are generally not advised for people with autoimmune issues (reference Dr. Perlmutter’s subsequent body of work, for example, author of Grain Brain).

In fact, you may find you need less restriction, such as a Modified Paleo Diet, as in what Dr. Perlmutter (author of Grain Brain, among other ground-breaking books) advocates. His is also a very healthful option that also enjoys the support of many other functional medicine practitioners in the field. Our family, for example, are currently in the Modified Paleo camp. This is largely because – just being honest – we find that we can do it. Grass-fed butter, for example, is allowed in a Modified Paleo Diet, where dairy is avoided altogether in more restrictive diets.

I also “modify” the Paleo diet a bit on my own, as tolerated. For example, we use unsweetened goat milk kefir in smoothies and as dessert; goat milk protein is fairly close to human protein in molecular structure, making it more easily tolerated in the digestive system, and the fermentation of the milk in the kefir product is very good for the gut (plus, it’s delicious). When we break diet, it’s to low-junk Gluten Free (GF) eating. We don’t digress beyond that because, quite frankly, it’s just not worth it. We’ve seen all too well the difference between GF eating and eating gluten and, once you’ve made the transition, you really just never go back. Being sick just gets old, and it’s not necessary anymore — eating GF is not like it was in the 1970s, where your alternative choices were cardboard. Today, it’s relatively easy (if you’re not Celiac – 100% restriction can be hard when eating out). Note that what I mean when I say low-junk Gluten Free is that many GF foods are loaded with sugar. So, you need to read the label.  Remember that eating Paleo on the whole is manageable. It’s available, and your key guide while out and about shopping and dining is “meat and vegetables.” That’s pretty easy to remember.

You may be interested in this video with Dr. Oz (12) on the Paleo diet. The focus is on losing weight as well as managing disease, and finding your “code” to help you succeed in sustaining a Paleo diet. It features Chris Kresser (13); note that he does talk about ways that you can potentially include foods that are typically inflammatory to most people with an autoimmune disease, like cow’s milk dairy and legumes, as part of this ‘individuation’ process. We’d recommend doing an elimination diet or discussing it with your practitioner before considering these – you need to know whether you can tolerate them – especially since there are such good alternatives, and it’s not necessary to risk symptoms to enjoy dining pleasure.

The best way to find out which diet is best for you is to do an elimination and reintroduction diet – Option 3 – observing symptoms throughout. This is really the only way to truly identify and achieve the widest diversity of foods that you can tolerate as an individual.

Option 3: Reset and replace using an elimination diet

For someone who’s struggling, an elimination diet is the way to go: you’ll get down to a core set of generally safe foods until symptoms subside, and then add back foods a little at a time, observing the impact, until you achieve the widest breadth of options that your individual body can tolerate. An elimination diet should be done with the supervision of a qualified practitioner from your medical team, especially when reintroducing foods.

The Paleo-based Autoimmune Protocol (AIP) (5) may not be simple and yet may be the easiest overall to implement, because you not only have two options for how to do it — one is to go “cold turkey,” and one is to transition to it over time — but you also have a wide and active community of bloggers for AIP, who help ensure that you’ll have a delicious experience not only with improved symptoms, but without a sense of deprivation. That counts for a lot when food has been a frenemy and is such a central part of what we call “comfort.” Yet it’s not an easy diet to follow — that’s why there’s so much dialogue about it, and lots of available menus, recipes, and plans because there’s a great deal that you “can’t eat” to follow AIP if you’re used to eating junk food and processed convenience foods. It’s definitely a whole-foods diet. There’s a lot you CAN eat. It’s based on the Paleo diet – back to how our ancestors safely ate before the age of manufactured foods — with a few more AI-specific filters applied.

Another elimination diet is the Institute for Functional Medicine’s (IFM) elimination diet (14). Where the AIP is an elimination diet specific to AI, and has undergone a clinical study that proves its efficacy for autoimmunity (15), the standard IFM elimination diet also focuses on reducing inflammation. It’s a good overall elimination diet that may help people get down to a core set of supportive foods that you can then build back from. I include it here to provide more than one option, but in the world of autoimmunity, as elimination diets go, the AIP seems to trump a general elimination diet because of its specific focus on autoimmunity.

Note two important points:

  1. an elimination diet is a short-term approach. The AIP, for example, is meant to be implemented for 30 to 90 days until symptoms subside. Then you start adding back individual foods a small bit at a time, observe results, and build from there.
  2. The end game is to net out with the widest variety of foods you can tolerate without triggering symptoms. On the one hand, the Top 5 inflammatory foods (gluten, sugar, dairy, legumes, bad fats) are never going to be on an anti-inflammatory dietary plan. On the other hand, however, a wide variety of foods are, because diversity not only makes for deliciousness; it also makes for a healthier gut and a wider variety of nutrients for the body to benefit from. This is another reason for the time limit in point 1.

Read our article, “3 ways to start The Autoimmune Protocol (AIP)” to learn more about this elimination and reintroduction dietary protocol to arrive at individualization.

Making friends with the process

Some folks find it difficult to take on an elimination diet and pursue a true individualization approach. Others need to dip a toe in the water, so to speak, when considering how food fundamentally affects health, and yet want to get started. Oftentimes, making just one significant change – like removing gluten from the diet – can have such a substantial effect on overall wellness that that big win inspires people to then want to look into what other possibilities for improvement they can achieve through food choices. Either way – whether all-in through the AIP or by another means of introduction – the important thing is to get started, and to understand that food is key to good health. “Food is medicine,” as the functional medicine practitioners say. More and more people are learning that truth through firsthand experience in dealing with autoimmunity.

So where does that put you in terms of making progress against inflammation, and avoiding foods that are known to cause inflammation and work against you? It puts you at Getting Started. Every one step forward you can take is a factor in the overall balance of managing multi-factorial disease.

Compliance and troubleshooting

Pursuing a 100% compliant diet – Paleo or otherwise – can remain an ambition as you also seek and find balance overall (work less, heal more).

We’re all in this journey together, and recovery is a continuum.

The key is to continue up the slope (I hear there’s a great view up there). We recommend at least striving for a “manageable” Paleo diet, whatever that means for you, i.e. including considering a food delivery service, such as from Paleo On the Go or SunBasket in the U.S., or recipe help like from RealPlans and/or, if appropriate, getting a jumpstart from an online course or nutritional coach (see Resources).

Petra Chambers-Sinclair, fellow AIP Certified Coach, runs “experiments” to track her and her husband’s progress through various diets. She found in her individual experience:

  • Diets that didn’t help (but one of them might work for you):
    The Specific Carbohydrate Diet, Vegetarianism, Raw Veganism, Low-Histamine.
  • Diets that did help:
    The Autoimmune Protocol, the Wahls Paleo Plus, the Bulletproof Diet, Low-FODMAP

Your individual results will vary. We found that, as a family, we didn’t want to run many experiments, and so went straight for a modified Paleo diet, which is working for us.

If you’re like me and don’t have the wherewithal for too much experimentation, start with whichever option — Option 1, 2, or 3 — you think is going to best work for you and start there. Observe results. You will learn. And then, if you need some further troubleshooting, discuss honestly how you’re executing the diet you’ve chosen. Robb Wolf of the Paleo community has a great troubleshooting guide on Eating for Autoimmunity (17) that helps people following the Paleo diet to easily discern whether you’re orchestrating the different factors that affect results of eating for autoimmunity, or whether a seemingly unrelated factor — like a lack of sleep – is really what’s skewing your results. Remember, autoimmunity is a multi-factorial disease. Diet is one factor. It’s a big one and yet, it’s one among several. You’ll want to take a look at your lifestyle, as well.

One step at a time. It’s progress!


See Also

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