What is Clinical Nutrition for Autoimmune Disease?Autoimmune diseases, such as rheumatoid arthritis and autoimmune thyroiditis, are becoming increasingly common. At Atlantic Medicine & Wellness, our autoimmune doctors believe that these conditions, as well as other autoimmune conditions, may be caused by a compromised gastro-intestinal environment, often accompanied by food sensitivities. Show Our Approach to Autoimmune Disease TreatmentAt Atlantic Medicine & Wellness, our autoimmune specialists believe in treating illness at the root cause level, rather than treating symptoms. We utilize advanced, innovative testing methods to identify underlying imbalances. We encourage patients to follow an individualized program that eliminates toxins and inflammation, heals the gastrointestinal lining and restores deficiencies that achieve homeostasis in the body. Autoimmune conditions require very specific dietary regimens that, when applied correctly, may dramatically improve our patients quality of life and get them back to optimal wellness. Atlantic Medicine & Wellness Center has a committed team of autoimmune specialists that can aid you in finding optimal health by restoring balance to your body. Contact us today to learn more or call 732-528-5533 to schedule your appointment with a NJ nutritionist. November 2011 Issue Is There a Link Between Nutrition and Autoimmune Disease? Should you follow a Paleo gluten-free diet or a vegan diet? Should you pop omega-3 or turmeric supplements? About 23 million people in the United States who suffer from autoimmune diseases face these questions every day. The Internet is teeming with books, websites, and blogs offering advice on how to eat to prevent or treat autoimmune conditions. Unfortunately, much of it is based on hype and hope instead of solid scientific evidence. What Is Autoimmune Disease? When everything goes right, your body’s immune response is a marvelous defense system, protecting against foreign invaders, injury, and infection through a complex communication system between your body’s cells and the chemical signals they produce. In a healthy immune system, this communication is clear and specific; the body can tell the difference between a foreigner and itself. But in autoimmune disease, the immune response is flawed, and the communication system breaks down. The body’s immune system takes aim at its own tissues. Either the immune system can’t distinguish the body’s tissues from foreign cells and begins to attack itself, or it’s unable to regulate the intensity of the immune response. Regardless, the result is damage to the body’s tissues and the development of an autoimmune disease. Autoimmune diseases can affect nearly every part of the body. Scientists have identified more than 80 clinically distinct autoimmune diseases, including systemic lupus erythematosus, type 1 diabetes, rheumatoid arthritis, Sjögren’s syndrome, multiple sclerosis, and chronic inflammatory bowel disease. For example, in Sjögren’s syndrome, your white blood cells attack moisture-producing glands, causing symptoms like dry eyes and dry mouth. And in type 1 diabetes, the immune system attacks the insulin-producing cells in the pancreas. People who suffer from autoimmune diseases often experience loss of function, disability, increased hospitalizations and outpatient visits, decreased productivity, and impaired quality of life. Looking for Answers Currently, researchers are beginning to understand that autoimmunity may play an important role in many chronic conditions, such as cardiovascular disease. In fact, the NIH established the Autoimmunity Centers of Excellence to promote research in areas such as lupus, multiple sclerosis, pemphigus vulgaris, rheumatoid arthritis, scleroderma, and Sjögren’s syndrome. The goal is to foster collaborative research across scientific disciplines and medical specialties to find effective treatments and prevention approaches. Role of Inflammation According to researchers, examples of autoimmune disease exist in the absence of overt inflammation and inflammation exists in the absence of autoimmunity. “Most autoimmune diseases aren’t caused by inflammation, although many autoimmune diseases cause inflammation,” Rose explains. “Some inflammatory processes may enhance the possibility of autoimmune disease in individuals with a genetic predisposition. Having inflammation may raise the likelihood of a subclinical autoimmune response reaching clinical thresholds. For example, this may occur in thyroiditis. We know that inflammation is caused by the same mediators often involved in the autoimmune process.” The Autoimmune Disease Specialty It’s been established that if you have one autoimmune disease, you’re at higher risk for developing others. For example, in celiac disease, which is an immune-mediated enteropathy triggered by the ingestion of gluten-containing grains in genetically susceptible persons, the comorbidity between other autoimmune diseases has been documented. “There’s a correlation between celiac disease and other autoimmune diseases, such as type 1 diabetes, autoimmune thyroid disease, Sjögren’s syndrome, autoimmune liver disease, inflammatory bowel disease, and Addison’s disease,” says Shelley Case, RD, a celiac disease diet expert and author of Gluten-Free Diet: A Comprehensive Resource Guide. “For example, the prevalence of celiac disease in type 1 diabetes is between 5% and 15%,” she says. Case asserts that dietitians need to be aware of these connections and that patients with these autoimmune diseases should be screened for celiac disease if they present with any symptoms related to gluten sensitivity. Case adds, “Dietitians need to specialize in autoimmune diseases such as celiac disease, as they are very complex conditions. Dietitians can do more harm than good if they just dabble in it. If dietitians don’t know this area well, they should refer a patient to a dietitian specializing in the specific autoimmune disease. That’s why family physicians frequently refer [patients] to specialists; we should have dietitian specialists, too.” Dearth of Dietary Treatment Strategies It’s important, however, to consider nutritional red flags that may arise during the management of autoimmune conditions. Typical drugs used in treatment, such as analgesics and nonsteroidal anti-inflammatory drugs, corticosteroids, disease-modifying drugs, and biologic response modifiers, may cause side effects such as nausea and vomiting, stomach pains, mouth sores, and decreased appetite. And some drugs can interact with specific nutrients, such as folic acid and vitamin B12. In addition, alterations in energy and protein metabolism that lead to muscle loss and wasting may occur in some autoimmune diseases. The nutritional management of autoimmune diseases usually emphasizes controlling pain and inflammation, slowing the progression of the disease, and boosting the immune system. And a few promising foods and nutrients are emerging as potentially beneficial. Let in the Sunshine Vitamin Many studies have explored the association between vitamin D and autoimmune disease. A November 2001 study published in The Lancet that followed participants for 30 years revealed that children born in Finland in 1966 who received supplemental vitamin D during the first year of life had a significantly lower risk for developing type 1 diabetes, while children with vitamin D deficiency during the first year of life had a significantly higher risk for developing type 1 diabetes. The Iowa Women’s Health Study found a lower risk of rheumatoid arthritis associated with higher vitamin D intake, according to the January 2004 issue of Arthritis & Rheumatism. Several studies suggest that vitamin D may lower the risk of developing multiple sclerosis, as well as lessen the frequency and severity of symptoms. According to Michael Holick, PhD, MD, director of the Vitamin D, Skin, and Bone Research Laboratory at Boston University School of Medicine, if you’re born below 35˚ latitude, located approximately at Atlanta and live at this latitude for the first 10 years of your life, you have a 50% reduced risk of developing multiple sclerosis. In addition, he reports that women and men who increase their vitamin D intake to more than 400 IUs per day reduce the risk of developing multiple sclerosis by approximately 40%. The Nurse’s Health Study also found a protective relationship between vitamin D supplements and multiple sclerosis risk, as was reported in Neurology in January 2004. And in a new study published in September in Neuroepidemiology, data from participants enrolled in the Multiple Sclerosis Surveillance Registry suggested that exposure to vitamin D before multiple sclerosis onset may slow disease-related neurodegeneration and delay progression to disability. How does vitamin D work in the immune system? In the 1970s, researchers discovered vitamin D receptors in many of the body’s cells, including islet cells of the pancreas, lymphocytes, and colon enterocytes. This led to the revelation that vitamin D helps keep the immune system functioning properly by inhibiting the proliferation of T cells and decreasing the production of proinflammatory cytokines. “Vitamin D deficiency may be more common in this country than we assumed,” Rose says. “There seems to be suggestive evidence on the role of vitamin D, but we have much to learn. There are no clinical studies yet showing that giving large doses of vitamin D benefits autoimmune disease. The level that we need to prevent disease and maintain health may not be the same.” The Microbiome and Autoimmunity Recently, the effects of probiotics on various autoimmune disorders have been investigated. Scientists are exploring how the microbiome (microbes, their genetic elements, and environmental interactions) may be different in children with type 1 diabetes compared with healthy children. In a January 2010 pilot study published in BMC Complementary and Alternative Medicine, a probiotic treatment resulted in improvement in pain and self-assessed disability in 45 adults with rheumatoid arthritis. And in a June 2006 review published in Postgraduate Medical Journal, Chinese researchers reported that preliminary studies suggest probiotics may be of benefit for colitis and inflammatory bowel disease because they may balance aberrant enteric microflora and reinforce the intestinal defense system. To be sure, the research in the field of probiotics and autoimmunity is still preliminary. “Probiotics are more popular than they’ve ever been, but there are several things that we don’t know yet. If you add relatively minor numbers of bacteria, can you actually change the balance of bacteria normally inhabiting the gut? Is it always a good thing to change the balance in the gut?” Rose asks. Look for future studies to answer some of these questions. Gluten Autoimmune Triggers Today, going gluten free is a popular treatment for many other autoimmune diseases outside of celiac disease, including lupus, multiple sclerosis, and rheumatoid arthritis. But is there proof that this approach works? “There’s no evidence that gluten-free diets will help all autoimmune diseases. But I do believe that many people with certain autoimmune diseases may have undiagnosed celiac disease. Should you tell everyone to follow a gluten-free diet? No. First, they should get tested if they have symptoms of a gluten sensitivity because if someone already is on a gluten-free diet, the celiac tests can be falsely negative,” Case says. Power of Omega-3 Fatty Acids The evidence on using omega-3 fatty acids in the treatment of chronic inflammatory bowel disease has been mixed. While some studies found a decrease in proinflammatory cytokines, a January 2009 review in Cochrane Database of Systematic Reviews determined that the existing data indicate omega-3 fatty acids are safe but probably ineffective for maintaining the remission of Crohn’s disease. In an August 2004 double-blind, placebo-controlled trial published in the Journal of Rheumatology, omega-3 fish oils improved symptomatic disease activity in patients with systemic lupus erythematosus. Anti-Inflammatory Eating “Antioxidants play a role in autoimmune disease. Celiac disease is an inflammatory disease. We’re finding that long after people are diagnosed and are following a gluten-free diet, their guts aren’t healed yet. It can’t hurt for people to eat more antioxidant-rich fruits and vegetables,” Case says. Donna Sigmond, MS, RD, a Colorado-based dietitian specializing in autoimmune diseases, enthusiastically recommends an anti-inflammatory diet to her patients. “I encourage green leafy veggies and other foods that can reduce inflammation, such as high-fat fish that contains fish oils. Seed oil from flax also can be beneficial. The focus should be to identify and eliminate inflammatory foods and nourish with real foods that deliver vitamins, minerals, and antioxidants,” Sigmond says. In a study published August 15, 2006, in the Journal of the American College of Cardiology, researchers found that diets high in refined starches, sugar, saturated fats, and trans fats and low in fruits, vegetables, whole grains, and omega-3 fatty acids appeared to turn on the inflammatory response. However, a diet rich in whole foods, including healthful carbohydrates, fats, and protein sources, cooled it down. There’s no harm in supporting a diet—optimal for just about everyone—that’s rich in whole plant foods, such as fruits, vegetables, whole grains, legumes, nuts, and seeds; is rich in healthful fat sources such as extra-virgin olive oil, avocado, nuts, and fish; and includes foods such as tea, dark chocolate, spices and herbs, and red wine in moderation. — Sharon Palmer, RD, is a contributing editor at Today’s Dietitian and a freelance food and nutrition writer in southern California. Can a nutritionist help with autoimmune disease?A number of dietary approaches can help in the prevention and management of autoimmune disease, but an individualized plan with the assistance of a dietitian and/or physician is recommended. Credentialed nutritionists caution against the AIP diet and other severely limited eating plans.
What foods to stay away from if you have autoimmune disease?The Autoimmune Protocol Diet
Foods to avoid include grains, legumes, dairy, processed foods, refined sugars, industrial seed oils, eggs, nuts, seeds, nightshade vegetables, gum, alternative sweeteners, emulsifiers, and food thickeners, said Romano.
What kind of doctor do you see for autoimmune deficiency?Rheumatologists specialize in diagnosing and treating musculoskeletal diseases and autoimmune conditions (rheumatic disease).
Who Specialises in autoimmune diseases?Rheumatologist. A rheumatologist treats arthritis and other rheumatic diseases, autoimmune and inflammatory diseases that can cause your immune system to attack its joints, muscles, bones, or organs.
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