Transcript Managing Autoimmune Disease with Diet

Managing Auto-Immune
Disease with Diet
Dr. Jaime Schehr
Goals & Objectives
• Identify how diet plays a major role in disease
management specific to immune disorders
• List specific questions practitioners should ask when
evaluating diet in auto-immune disease
• Learn key facts for dietary management of specific
auto-immune diseases
• Take an In-depth look at management of IBD
Where to Start
• Does patient have diagnosis or do you suspect?
• Has patient yet made dietary modifications for this
condition?
• Diet? lifestyle ? exercise? 
Supplementation?other
The “Other” Important
Questions
Beyond diet recalls and diet diaries….
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Environment
Gut
Energy
Medications
Family History
Food allergies vs. sensitivities
Trigger Event / Emotional
How to Chose the diet Rx
Not all Food is Created Equal
Grant Cornett for The New York Times
Immune Supportive Foods
• Fermented Foods / Probiotics
• Nutrient Dense (ANDI, Superfoods)
• Anthocyanidins, flavonoids (insert food
sources)
Immune Disruptive Foods
• Pro-Inflammatory Foods
• Food Sensitivities / Food Allergens
• Chemically Altered Foods
• False or Fake Foods
3 Ways to Identify Food Sensitivities
Elimination diet
• Involves avoiding top food allergens for total of 6 weeks.
Reintroduce foods one group at a time at least 2-3x day for 3 days.
Avoid symptom positive foods for 90 days
Modified Elimination diet
• Removing one or two problematic foods at a time to reduce
symptom picture and allow gut healing
Blood Testing
• IgG food antibodies*
• IgE food antibodies*
• *know the difference between these two
Oligoallergenic Diet
aka Allergy Elimination Diet
Oligoallergenic Diet:
This diet is exactly what its name sounds like: a small number of foods which are
deemed unlikely to cause an allergic reaction are eaten for a period of time. If this
diet is used as a diagnostic tool, then foods are gradually added back one at a time
to see if symptoms reappear. Examples of foods commonly used on this diet
include lamb, rice, turkey, and pears, all of which are considered unlikely to cause
allergic reactions.
Why introduce an allergy elimination diet?
The immune barrier aspect of gastrointestinal health is important in evaluating
adverse immune reactions to food and predicting overall intestinal health.
Assessments of food reactions offer practical information regarding food choices
that enhance health restoration in the patient with compromised GI function.
Elimination Diet
Foods to Avoid
Dairy
Wheat
Corn
Soy
Egg
Citrus
Caffeine
Alcohol
Sugar
Food Additives
Frequently eaten foods
Processed foods
Known Allergens
Peanuts
Foods to Include
Gluten-free grains and flours
Fruits
Vegetables
Legumes
Meat proteins
Nuts
Seeds
Oils (not corn or canola)
Fats (non-dairy)
Anti-Inflammatory Foods
• Anti-inflammatory diet – whole foods, plant based, low glycemic load
• Foods with high omega-3 fatty acids, such as cold water fish, flaxseeds,
walnuts
 A balanced intake of omega-6 and omega-3 fatty acids is anti-inflammatory
 Overconsumption of omega-6 fats in relation to omega-3 fats leads to inflammation
 Most appropriate ratio of omega-6 to omega-3 fatty acids is approximately 4:1.
This requires increasing the intake of omega-3s and decreasing intake of omega-6s
• Foods with high levels of antioxidants, such as vegetables, citrus fruits,
cherries, garlic, onion and tea
• Spices, in particular, ginger, garlic, rosemary, turmeric, oregano, cayenne,
clove and nutmeg
• Low glycemic index/load foods
Anti-inflammatory Food Choices Chart
Food Category
Foods to Eat
Foods to Avoid
Vegetables: Eat mostly lower carbohydrate
vegetables. Lower carbohydrate foods turn to
sugar more slowly in the body. Steaming
vegetables improves the utilization or availability
of the food nutrients allowing the GI mucosa to
repair itself.
Asparagus, bean sprouts, beet greens, broccoli, red and green
cabbage, cauliflower, celery, Swiss chard, cucumber, endive,
lettuce (green, red, romaine, mixed greens), mustard and
dandelion greens, radishes, spinach, and watercress.
String beans, beets, bok choy, Brussels sprouts, chives,
collards, eggplant, kale, kohlrabi, leeks, onion, parsley, red
pepper, pumpkin, rutabagas, turnips, and zucchini
Artichoke, parsnip, green peas, squash, and carrot
Yams and sweet potatoes
Tomatoes
Potatoes
Egg plant
Green peppers
Grains: Include 1-2 cups of cooked grains per day Amaranth, barley, buckwheat, millet, oatmeal, quinoa,
basmati or brown rice, rye, and teff.
Rice crackers and wasa crackers are also o.k.
All wheat products including breads, cereals,
white flour, and pasta made from wheat.
Seafood: Deep sea-ocean fish are an excellent
source of essential fatty acids and should be eaten
3-4 times per week.
Meat: Eating protein with every meal helps to
regulate and maintain steady blood sugar and
energy.
Wild salmon, cod, haddock, halibut, mackerel, sardines,
tuna, trout, and summer flounder. Poach, bake, or broil wild
cold water fish (vs. farmed).
Shellfish: Shrimp, crab, lobster, and clams.
Eat only the meat and not the skin of organic or free-range
chicken and turkey. Wild game, venison, elk, and lamb are
also fine.
Spices
Add any favorite natural spice to enhance the flavor of your
food
Fruit: Eat only 1-2 pieces of practically any fruit
per day.
Cantaloupe, rhubarb, melons, and strawberries
Apricot, blackberries, cranberries, papaya, peach, plum,
raspberries, and kiwi
Apple, blueberries, cherries, grapes, pear, pineapple,
pomegranate
raw honey or stevia or raw organic agave nectar
Beef
Pork
Some organic beef/buffalo is OK in small
amounts
Adobo, sazon, seasonal, salt seasonings bullion
cubes
Citrus fruits.
Lemon is OK
Sweeteners: Use sweeteners only occasionally
Butter and oils
Nuts and seeds
Drinks
extra virgin olive oil to use as a spread or for cooking.
coconut oil only for baking
nut or seed or olive oils for salads
earth balance buttery spread
Ground flax, pumpkin, sesame, or sunflower seeds and add
to steamed vegetables, cooked grains, etc. Most nuts and
seeds are OK including nut butters.
WATER. A small amount of rice, oat, almond, or soy milk
are ok. Herbal teas can be great coffee and juice substitutes.
Avoid Sugar, Splenda, Nutra-sweet, Equal, Swee
& Low, Sugar substitites
Peanut oil
Peanuts and peanut butter.
Coffee, soda, juice, caffeinated teas, or alcohol.
Nutrient Value of Foods Important in Auto-Immune Diseases
Vegetable
ANDI Score
Vegetable
ANDI Score
1. Mustard/Turnip/Collard
1000
Greens
1. Radish
502
2. Turnip
473
2. Kale
1000
3. Carrots
458
3. Swiss Chard
1000
4. Acorn Squash
444
4. Upland/Watercress
1000
5. Broccoflower
444
5. Bok Choy/Baby Bok Choy 865
6. Cabbage
434
6. Chinese/Napa Cabbage
714
7. Bell Pepper, Yellow
371
or Orange
7. Spinach
8. Arugula
707
604
9. Lettuce, Green Leaf
585
10. Chicory
516
8. Kholrabi
352
9. Cauliflower
315
10. Rutabaga
296
Rheumatoid Arthritis
• Optimize omega 3:6 ratio to reduce jt. stiffness &
tenderness
• Turmeric, 1 tsp (5 mL) each meal as spice or capsules.
• Polyphenols (e.g. from grapes) (preliminary evidence)
• Lower red meat
• High antioxidant foods, e.g. green tea, soy, cherries,
garlic, ginger
• Folic acid 1 mg/d
Rheumatoid Arthritis
• Optimize Vitamin D – consider maintaining higher
levels, e.g. 50 – 70 ng/mL
• Pomegranate extract
• Green tea extract
• Selenium: Dosage: 200 mcg daily is standard and 400
mcg daily is the maximum.
• CoQ10
• Probiotics
Hashimoto’s
• High protein breakfast
• Correct nutrient deficiencies
• Avoid Food Sensitivities
• Wheat free (not-gluten free)
• Foods with thyroid co-factors (brazil
nuts, seaweed)
Celiac Disease
Beyond Gluten Free:
- high sources glutamine for gut repair
- r/o food sensitivities – common dairy
sensitivity
- B12/B6  supplement vs. food; nutritional yeast
- constipation post gluten elimination  non-gluten
sources digestible fibers
An In-depth Look ….
• The following slides will take an in-depth look at
integrative nutrition management of an autoimmune disease:
Irritable Bowel Disease
Irritable Bowel Disease
Clinical Management must be differentiated from IBS
Chrons Disease
inflammation in the bowel
can affect any part of (GI) tract
most commonly SI
inflammation through the entire
thickness of the intestinal wall
• Sx: abdominal pain, bloody
diarrhea, fever weight loss
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Ulcerative Colitis
• inflammation in the bowel
• usually involves only the
colon
• inflammation limited to
inner surface layers of the
intestine
• Sx: abdominal pain, weight
loss, diarrhea
Irritable Bowel Disease
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Diagnosis includes activation of the immune system
(think genetic  ask about family)
(think environmental  ask about lifestyle)
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Some theories correlate activation of disease to food allergens or food
sensitivities
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Some theories suggest possible correlation to microbiome
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Active disease positive for elevated immune cells in intestinal tissue
(i.e lymphocytes, macrophages).
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Elevated levels of inflammatory cytokines such as interleukin-1 (IL-1),
interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor
alpha (TNF-alpha) may be present
IBD: Symptomology
• Common for sx to relapse & remit : Be careful not to
associate this with “cure” and thus change diet too
quickly
• Patient can be symptom free for months/years
• Acute attack can last weeks to months
IBD Dietary Management
• Restore Nutrient deficiencies
• May require vegetables to be cooked
• Avoid Stimulant Foods (spicy foods, coffee)
IBD Management
• Essential Fatty Acids - anti-inflammatory and
immunomodulatory effects
• Probiotics – as immuno-modulators (by stimulating
lymphocyte and macrophage activity and cytokine
production and increasing IgA
• Psyllium - fermentation in gut produces butyrate.
Butyrate (a SCFA) has an anti-inflammatory effect and
inhibits cytokine production
• Antioxidants
IBD: Nutrient Deficiencies
Widespread nutrient deficiency possible secondary to absorption difficulties:
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Calcium
Vitamin B12
Folic Acid
Magnesium
Niacin
Vitamin B1
Vitamin D
Vitamin K
Zinc
Vitamin A
Vitamin E
Iron
Glutamine
IBD: Red Flags
• Severe acute colitis may require hospitalization for
adequate nutrition and bowel rest
• Patients with severe colitis are also at risk for toxic
megacolon
• NSAIDs may impair GI healing; avoid in patients
with IBD
• Patients with UC may have difficulty absorbing
folate
IBD: Clinical Pearls
• Patients with UC using sulfasalazine therapy will
need folate supplement. (Sulfasalazine inhibits absorption of folic
acid in the intestine)
Conclusion
• Most AI diseases will benefit from whole foods plant
based approach
• Always rule out food sensitivities
• Supplement therapy may be critical for these patients
• Diet Therapies can have profound improvement on
patient symptoms