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Diet and Autoimmune Disease

Introduction

Autoimmune diseases are triggered not only by your genetic makeup, but the impact environmental factors have upon the expression of various genes. Your stress-level, sleep habits, foods you consume, and exposure to various toxins, all play some role on whether a gene is turned on or off. Therefore it is important to understand how external factors, especially your diet, can influence your gene expression. Unfortunately, in the case of autoimmune disorders, current interventions can only dampen some of the painful symptoms associated with the disease. Here we discuss various diet interventions that may be beneficial in symptom management of your autoimmune disease.

Your Gut and Your Health

Scientists are increasingly gaining new insight on the concept, ‘you are what you eat.’ This relationship is no better demonstrated than the role diet plays upon your gut and overall health. We rely on our intestines as the main method to absorb needed nutrients, vitamins, and water. To maximize the nutritional value from our food, our ancestors evolved a beneficial relationship between the bacteria that reside in our gut, in exchange for improved nutritional absorption. This relationship is so crucial that the immune system of our intestines has developed an intricate way of identifying and tolerating a wide-array of beneficial bacteria.

Yet the advent of the western diet, which is primarily characterized by the consumption of energy-dense, processed foods at the expense of nutrient-rich foods, such as fruits and vegetables, is detrimental to this vital relationship between our gut microbiome and our health (1). One study found that individuals who had a lower amount of microbiome diversity, meaning the variety of different types of bacterial species residing in their gut, showed increased likelihood of developing insulin resistance, and fat accumulation, compared to individuals with high bacterial diversity (2). The effects of poor gut health and damage to the lining of the gut is compounded in autoimmune disorders. The consumption of foods that trigger an autoimmune response within the gut, face not only decreased nutritional absorption, but an increased occurrence of unnecessary inflammatory flare-ups. Therefore, researchers have investigated the impact various types of foods, patterns of eating, and caloric restriction have upon lowering this inflammatory response.

The Gluten-Free Diet

The gluten-free diet, originally developed for individuals diagnosed with Celiac disease, requires the elimination of various grains such as wheat, barley, and rye as they contain gluten. Exposure to gluten in individuals diagnosed with Celiac disease or who are deemed gluten-sensitive, activates the immune system, causing damage to the small intestines, which if persists, can eventually result in malnutrition, osteoporosis, and weight-loss, due to poor intestinal nutrient absorption. Individuals that undergo a gluten-free diet report having improved symptom management, such as decreased occurrence of headaches, lower-fatigue, decreased muscle and joint pain, and decreased development of gastrointestinal distress.

The gluten-free diet has also been found to be beneficial in individuals with other autoimmune diseases. A study conducted in 66 patients with active Rheumatoid Arthritis (RA) either followed a gluten-free vegan diet or a healthy non-vegan diet for 1 year. 40.5% of those in the gluten-free vegan diet improved, based upon the standards provide by the American College of Rheumatology (ACR), whereas only 4% of those in the healthy non-vegan diet improved (3). Another study found that a gluten-free diet resulted in improved symptoms management associated with irritable bowel disease (symptoms consist of chronic abdominal pain and bloating), and fibromyalgia (chronic-widespread pain, fatigue and restless sleep) (4). Combined, these results indicate how gluten may act as an autoimmune trigger. For those who are gluten-sensitive, the removal of the protein may provide immediate joint pain relief, however results are highly dependent upon an individual’s genetic makeup and should consult with their physician before undergoing any drastic dietary changes.

The Vegan-Diet

Unlike the vegetarian diet, which excludes only meat, fish, and poultry, the vegan diet completely eliminates all animal-based products, including dairy and eggs. Individuals following this regime primarily consume fruits, vegetables, leafy greens, grains, nuts, and legumes that are consumed either uncooked or only lightly cooked. Due to the low amounts of Vitamin B12, it is recommended that individuals on this diet consume it as a supplement. The heavy emphasis on a plant-based diet, which was later-dubbed the ‘living diet,’ has been shown to reduce the risk of heart disease, various forms of cancer, and high cholesterol (5). In addition, vegetable-rich diets contain large amounts of fiber, which is highly beneficial for proper gut function.

Though the vegan approach appears to be limiting in the types of foods consumed, it does force the elimination of foods that have been linked to triggering an inflammatory response. This is especially evident in individuals suffering from fibromyalgia. Individuals who voluntarily followed the vegan-diet, showed short-term symptom improvement (6). As well, people with Rheumatoid Arthritis, demonstrate improved symptom management and undergo a beneficial change in their microbiome, showing a one-fold increase in ‘good’ bacteria (7).

However, due to the highly restrictive component of the vegan diet, it makes it difficult for long-term compliance. It is also important that individuals should seek physician guidance before switching to vegan, to ensure all nutrients and vitamins are met.

The Mediterranean Diet

Over recent years, the Mediterranean diet has gained increased prevalence, due to the high concentration of centenarians that reside in this region. To better understand the increased lifespan and overall good health, scientists investigated the dietary intake of these individuals. They discovered that the Mediterranean diet, so called for its origins in Greece and Southern Italy, is primarily a plant-based diet, with heavy consumption of fruits, vegetables, legumes, and nuts, with dairy and poultry products limited to only a small portion of their daily calories. As well, fish and seafood is consumed at least twice per week, and there is very little intake of saturated fats, such as butter, which is instead replaced with olive oil, a source rich in omega-3. Red meat is consumed rarely, limited to no more than two times per month.

For those with Rheumatoid Arthritis, a diet rich in fish, olive oil, and cooked vegetables has been shown to protect against the painful joint symptoms that accompany RA flare-ups. In addition, several studies have found that the population of southern Europe typically has a milder form of symptoms associated with RA compared to other populations, with many ascribing this difference partly to the prominence of the Mediterranean diet. As well a diet high in Vitamin D (primarily from dairy) and Vitamin K (primarily found in legumes and other vegetables) may help to lower the severity of the RA inflammatory response (8).

The Paleo Diet

The Paleolithic diet, or better known as the ‘paleo diet,’ is based upon the diet of our ancestors, specifically the time-period from 2 million to 10,000 years ago when humanity transitioned towards an agrarian society, which is centered upon the cultivation of grains and animal domestication. Prior to this period, humans were hunter-gatherers, relying upon wild-animals as their primary protein source and uncultivated plants (such as berries, root vegetables, and nuts) as nutrient supplementation. The paleo diet focuses on the consumption of lean meats, fish, fruits, vegetables, root vegetables, eggs, and nuts, with no dairy or refined grain intake.

Hence, some scientists have argued the paleo diet is better suited for our bodies, as evolution had little time to prime our bodies for the huge dietary shift that accompanied the agricultural revolution and animal domestication (9). Our current day diets are energy-rich, but nutrient-poor, with heavy appeal to our evolutionary physiology: high amounts of fat and sugar. To our Paleolithic ancestors, these ingredients were rare, but in our present environment, they are in excess. Hence, our diets have shifted away from the consumption of lean animal-source protein and fruits and vegetables, which are high in needed vitamins, to those high in salt and refined carbohydrates, which some scientists believe contributed to the development of ‘diseases of civilization,’ consisting of many of the chronic diseases we currently face: insulin resistance, Typepa II Diabetes, cardiovascular disease, osteoporosis, and certain types of cancers (10). One study found that non-obese healthy individuals on the paleo diet, showed improved blood pressure and decreased blood glucose levels (11). A similar study, which compared the paleo diet to that of the Mediterranean diet, found improvement in blood glucose levels in patients with Type II Diabetes, and proposed that it is not the number of calories that are important, but avoiding westernized, highly processed foods that has the greatest impact on our overall health (12).

The resurgence in popularity of the paleo diet has largely been shown not only as a weight-loss approach, but has been scientifically shown to be beneficial for individuals with cardiovascular disease or Type II Diabetes. However, very limited studies have focused on understanding the possible benefits that accompany the paleo diet for individuals with an autoimmune disease. Work by Dr. Loren Cordain, an exercise physiologist, argues that the paleo diet may provide beneficial outcomes for those with autoimmune diseases, specifically irritable bowel syndrome. However, much of this work is anecdotal.

Body weight, inflammation, and fasting

The benefits of transitioning away from a diet rich in saturated fats, is not only beneficial in decreasing the painful symptoms associated with an autoimmune disease, but for overall improved health. Multiple studies have shown diets high in saturated fats and excess sugar and salt, increase the risk for developing heart disease, cancer, and type II diabetes, with each accompanied by a plethora of health problems, to increased risk of death (13).

High fat diets promote the accumulation of white adipose tissue. Our bodies have two types of fat storage: brown adipose tissue (BAT), and white adipose tissue (WAT). Brown fat is used by our bodies during periods of cold. When we feel cold, our brown fat is stimulated and uses energy to produce heat, ensuring we have a constant core temperature. Hence brown fat has been dubbed as the ‘good’ fat in our bodies. In contrast, white fat is not simply a means for long term energy storage. Instead, it has been viewed as a not-so beneficial ‘hormone-producing organ.’ This means that white fat can release various pro-inflammatory signals that can trigger chronic systemic inflammation.

In addition, high fat diets have been found to exacerbate the symptoms associated with arthritis. Leptin, a hormone released by white fat, has been found to be a critical regulator of energy balance and body weight, and can stimulate the immune response by increasing T-cell production. Some studies have shown that leptin levels are reduced following a 48-hour fasting period, coinciding with decreased symptom flare-up. Another study found that intermittent fasting, over a 1 to 3 week period, resulted in both decreased inflammation and pain for RA patients. Of note, the inflammatory flare-ups returned once a normal diet resumed. Hence, long-term fasting cycles, may provide symptom alleviation for individuals suffering from RA. However, it is critical individuals who embark upon intermittent fasting, especially periods lasting longer than 24 hours, should be done under the supervision of a physician (14)

Summary

It is important to emphasize that one of the primary uniting factors between these various diets is the transition away from consuming highly processed ‘westernized’ foods towards nutrient-packed foods. It is also important to state that though these diets do provide symptom relief for individuals with an autoimmune disease, each person is unique and will respond to these diets differently. It is recommended that each patient who tries any of these diets assess how the food modifications impact symptom management and overall well-being. It is also highly recommended to speak with your physician before switching to any of these diets, to ensure all nutrients are being fulfilled and there is no negative interaction with concurrent treatments.

References

1. Manzel, A., Muller, D., Hafler, D., Erdman, S., Linker, R., and Kleinewietfeld, M. (2013) Role of “Western Diet” in Inflammatory Autoimmune Diseases. Curr Allergy Asthma Rep 14, 1-8
2. Le Chatelier, E., Nielsen, T., Qin, J., Prifti, E., Hildebrand, F., Falony, G., Almeida, M., Arumugam, M., Batto, J.-M., Kennedy, S., Leonard, P., Li, J., Burgdorf, K., Grarup, N., Jorgensen, T., Brandslund, I., Nielsen, H. B., Juncker, A. S., Bertalan, M., Levenez, F., Pons, N., Rasmussen, S., Sunagawa, S., Tap, J., Tims, S., Zoetendal, E. G., Brunak, S., Clement, K., Dore, J., Kleerebezem, M., Kristiansen, K., Renault, P., Sicheritz-Ponten, T., de Vos, W. M., Zucker, J.-D., Raes, J., Hansen, T., Meta, H. I. T. c., Bork, P., Wang, J., Ehrlich, S. D., and Pedersen, O. (2013) Richness of human gut microbiome correlates with metabolic markers. Nature 500, 541-546
3. Hafström, I., Ringertz, B., Spångberg, A., von Zweigbergk, L., Brannemark, S., Nylander, I., Rönnelid, J., Laasonen, L., and Klareskog, L. (2001) A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens. Rheumatology 40, 1175-1179
4. Vazquez–Roque, M. I., Camilleri, M., Smyrk, T., Murray, J. A., Marietta, E., O'Neill, J., Carlson, P., Lamsam, J., Janzow, D., and Eckert, D. (2013) A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function. Gastroenterology 144, 903-911. e903
5. Fraser, G. E. (1994) Diet and coronary heart disease: beyond dietary fats and low-density-lipoprotein cholesterol. The American journal of clinical nutrition 59, 1117S-1123S
6. Kaartinen, K., Lammi, K., Hypen, M., Nenonen, M., Hänninen, O., and Rauma, A.-L. (2000) Vegan diet alleviates fibromyalgia symptoms. Scandinavian journal of rheumatology 29, 308-313
7. Hänninen, O., Kaartinen, K., Rauma, A. L., Nenonen, M., Törrönen, R., Häkkinen, S., Adlercreutz, H., and Laakso, J. (2000) Antioxidants in vegan diet and rheumatic disorders. Toxicology 155, 45-53
8. Tobón, G. J., Youinou, P., and Saraux, A. (2010) The environment, geo-epidemiology, and autoimmune disease: Rheumatoid arthritis. Journal of Autoimmunity 35, 10-14
9. Cordain, L., Eaton, S. B., Sebastian, A., Mann, N., Lindeberg, S., Watkins, B. A., O'Keefe, J. H., and Brand-Miller, J. (2005) Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr 81, 341-354
10. Sebastian, A., Frassetto, L. A., Sellmeyer, D. E., Merriam, R. L., and Morris, R. C., Jr. (2002) Estimation of the net acid load of the diet of ancestral preagricultural Homo sapiens and their hominid ancestors. Am J Clin Nutr 76, 1308-1316
11. Frassetto, L. A., Schloetter, M., Mietus-Synder, M., Morris, R. C., Jr., and Sebastian, A. (2009) Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet. Eur J Clin Nutr 63, 947-955
12. Lindeberg, S., Jönsson, T., Granfeldt, Y., Borgstrand, E., Soffman, J., Sjöström, K., and Ahrén, B. (2007) A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia 50, 1795-1807
13. Willett, W. (2012) Dietary fats and coronary heart disease. Journal of internal medicine 272, 13-24
14. Longo, Valter D., and Mattson, Mark P. (2014) Fasting: Molecular Mechanisms and Clinical Applications. Cell Metabolism 19, 181-192