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What To Eat If You Have An Autoimmune Disease: An MD's Top 4 Principles
What you eat and drink can be the potential cause of autoimmunity, or the most nourishing influence in terms of helping to prevent or reverse autoimmunity. But what principles should you keep in mind when you eat for the long term? There are four main areas to address via nutritional modulation when you have an autoimmune disease: nutritional gaps, poor digestion, toxic backlog, and blood sugar spikes. Let's dig into the importance of each:
Nutritional gaps
When I take care of a patient with autoimmune disease, or a pre-autoimmune condition, I look first for nutritional insufficiencies and deficiencies because they are common. They occur from eating the typical Western diet: inflammation, celiac, imbalanced gut microbes, and food sensitivities.
Micronutrients are essential dietary elements—vitamins and minerals—that you need for physiological function and optimal health, like B vitamins and magnesium. The amount you need varies depending on life stage—you'll need more as an adolescent and in pregnancy and usually less as you age.
Micronutrients are not usually produced in the body and must be obtained from the diet (the one exception is vitamin D, which your body makes when exposed to natural sunlight). Macronutrients are the dietary elements that we need in higher quantities to obtain energy: fat, protein, and carbohydrates. Both micronutrients and macronutrients can be inadequate for your needs.
Poor digestion
When your digestive tract is not doing its job—which is to process food, fuel your cells, and eliminate waste—you may feel symptoms such as the following, all of which are common in autoimmune disease:
- Fatigue
- Bloating
- Constipation
- Diarrhea
- Heartburn
- Bleeding
- Fecal incontinence
- Nausea
- Abdominal pain
Digestion is tricky to figure out, so I recommend working with a functional medicine clinician to learn how to assess and address it. Most of my patients need additional functional testing and supplements that help them digest food, such as betaine HCl and digestive enzymes.
Toxic backlog
You may wonder how toxins and autoimmunity relate to each other. We get hit by toxins daily—they are found in makeup, skin creams, furniture, water bottles, and cleaning products in the home.
Much of the toxins work to disrupt your delicate hormone balance, and while one toxin on its own may not be enough to cause symptoms, the cocktail of many at once can be enough to cause problems with hormones and blood sugar1 such that increased inflammation is triggered. In someone who is vulnerable to autoimmunity, this can sometimes be a trip wire to cause illness.
I find that about half of my patients have sluggish detoxification pathways that they inherit, leading to a buildup of toxins in the body. These toxins get stored in fat instead of being correctly excreted in urine, stool, and sweat, so one of our first tasks together is to improve detoxification while also reducing toxic load, starting first with food and then moving on to lifestyle.
Tried juicing as a way to detox? I'm not usually a fan of juice other than as an occasional treat. Eating organic foods, eating and drinking from glass containers, and limiting the use of plastic can make a big difference, as can increased sweating through exercise and taking sauna.
Blood sugar spikes
Blood sugar problems can be common in autoimmune disease, including Type 1 diabetes, autoimmune thyroiditis, and likely others as well. When we look to the root cause, sometimes it is related to increased stress and perhaps underlying trauma leading to adrenal glands that produce excess cortisol. High cortisol raises blood sugar and can also trigger a greater immune response.
The typical spiky blood sugar response to food can be seen in someone like me, who has a significant trauma load and stress. I eat an apple (or some other food with a substantial amount of carbohydrates), and it triggers excessive insulin release. My blood sugar rises steeply from the apple and then crashes from the exaggerated insulin release so that I have a big spike of glucose that goes way up and then way down. You can see these types of responses in a device like a continuous glucose monitor.
In terms of what you feel, you might immediately notice symptoms like fatigue and a drop in energy, anxiety, panic, and lightheadedness, but it also overtaxes the adrenal glands over time. When you learn how to eat in a way that stabilizes blood sugar, you'll find that you feel more energy and calm.
Why fiber is the unsung hero of autoimmune recovery
As the unsung hero of autoimmune recovery, fiber helps you detoxify because it binds to toxins in your gut and escorts them to the door—out of your colon and into the toilet. It can also help prevent you from reabsorbing them. When you eat foods that are rich in dietary fiber, like fruits and vegetables, the gut microbiota ferments the fiber into beneficial molecules called short-chain fatty acids, which have anti-inflammatory effects as shown in the massive study by the Women's Health Initiative2 (whose results on hormone replacement therapy have been revisited and partially debunked but which still hold merit for other findings).
You can count how many grams of fiber you are consuming each day either manually or with an app. Aim for 30 to 40 grams per day, but if you're way below that dose, like most people, slowly increase by no more than 5 grams per day to avoid bloating, cramping, and constipation. Our hunter-gatherer ancestors ate 50 to 100 grams of fiber per day, but our guts may struggle with that much.
The takeaway
While I agree that the gut is at the root of autoimmune disease, and the best way to upgrade the gut is with food, we are still a long way from knowing exactly what works best. And food isn't the only tool in your toolbox, as there are many other environmental, social, and lifestyle issues that we now know can promote chronic inflammation, potentially leading to cardiovascular disease, cancer, diabetes, chronic kidney disease, neurodegenerative disorders, and autoimmunity3.
Adapted from an excerpt of The Autoimmune Cure: Healing the Trauma and Other Triggers That Have Turned Your Body Against You by Sara Szal Gottfried M.D., with permission from the publisher.
Sara Szal Gottfried MD is a physician, researcher, author, and educator. She graduated from Harvard Medical School and MIT, and completed residency at UCSF, but is more likely to prescribe a continuous glucose monitor and personalized nutrition plan than the latest pharmaceutical. Dr. Gottfried is a global keynote speaker and the author of four New York Times bestselling books about hormones, nutrition, and health. Her latest book is called The Autoimmune Cure (March 2024). She is Clinical Assistant Professor in Dept. of Integrative Medicine and Nutritional Sciences at Thomas Jefferson University, and Director of Precision Medicine at the Marcus Institute of Integrative Health. Her focus is at the interface of mental and physical health, N-of-1 trial design, personalized molecular profiling, use of wearables, and how to leverage these tools to improve health outcomes. Learn more at SaraGottfriedMD.com
More from the author:
How To Balance Your Hormones
Check out Correct Hormone Imbalance For Better Skin, Improved Digestion & Less Fatigue
More from the author:
How To Balance Your Hormones
Check out Correct Hormone Imbalance For Better Skin, Improved Digestion & Less Fatigue
Sara Szal Gottfried MD is a physician, researcher, author, and educator. She graduated from Harvard Medical School and MIT, and completed residency at UCSF, but is more likely to prescribe a continuous glucose monitor and personalized nutrition plan than the latest pharmaceutical. Dr. Gottfried is a global keynote speaker and the author of four New York Times bestselling books about hormones, nutrition, and health. Her latest book is called The Autoimmune Cure (March 2024). She is Clinical Assistant Professor in Dept. of Integrative Medicine and Nutritional Sciences at Thomas Jefferson University, and Director of Precision Medicine at the Marcus Institute of Integrative Health. Her focus is at the interface of mental and physical health, N-of-1 trial design, personalized molecular profiling, use of wearables, and how to leverage these tools to improve health outcomes. Learn more at SaraGottfriedMD.com
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