How can an anti-inflammatory diet help my autoimmune condition?
What has inflammation got to do with autoimmunity?
Inflammation is central to autoimmunity. Excessive, chronic inflammation plays a key role in driving both the development and the progression of autoimmune conditions. This is because excessive, chronic inflammation interferes with our ability to maintain immune tolerance. We begin to react to foods and other substances we were previously tolerant to, sparking a cascade of further inflammation, immune intolerance and additional reactions, all of which may drive autoimmunity in genetically-susceptible individuals.
For some people, diet will have played a fundamental part in the development of their autoimmune disease; perhaps through food allergies or certain toxins that have damaged their gut lining leading to a loss of immune tolerance. For others, non-dietary factors will have created the conditions for autoimmunity to develop, always, of course, against a backdrop of genetic predisposition.
How can an anti-inflammatory diet help my autoimmune condition?
Regardless of whether diet played a pivotal role in the development of your autoimmune condition, it has the ability to play a fundamental role in determining the future progression of your autoimmune condition.
The weight of research behind the role of the diet in inflammation and autoimmunity is now impossible to ignore and is increasing year on year. Yet many people find this a confusing area of health. The first reason for this may be that diet influences inflammation in several different ways. These ways are broken down into categories below. The second reason may be that we know the diet’s influence is highly personalised and will affect each individual differently. Nevertheless, there are common threads running through the science behind the various mechanisms of an anti-inflammatory diet. These common threads are also set out for you below.
We’ll look at three areas:
foods that contribute to inflammation;
foods that repair damage caused by inflammation; and
foods that promote immune tolerance.
1) Foods that contribute to inflammation in autoimmunity.
Let’s start by looking at foods that actively contribute to inflammation, which leads to tissue damage, particularly in the gut lining, and promotes immune intolerance.
Foods can contribute to inflammation in a number of ways:
Omega 6: Omega 3 ratio
The ratio of omega 6: omega 3 fats in our body is important. If this ratio dips too far out of range, our immune systems struggle to maintain immune tolerance. We need a ratio of around 3: 1 of omega 6 to omega 3 fats. The average American currently has a ratio of around 16 : 1. This is because the Western diet unfortunately contains.an extremely high amount of omega 6 fats.
Balance your omega-6: omega-3 ratio to reduce inflammation
Looking at the food groups above, it is easy to see why this ratio is out of range for many of us. There is an opportunity to reduce inflammation if we can readdress this balance. Personalised nutrition advice can help here if you are unsure how to go about this.
Ultra processed foods
Many people struggle to understand what ultra processed foods are. After all, many foods are processed, and not all processes are damaging. In fact some, such as fermenting, can provide additional health benefits.
Ultra processing refers to processes such as UHT (ultra high temperature), the removal of part of the food, such as fibre, or the adding of trans fats or other chemicals such as antibiotics, additives or preservatives to foods which render these foods unrecognisable to the body. Some of these substances damage the gut wall, leading to hyper-permeability and inflammation. Others are unable to be processed and eliminated properly and are added to the body’s toxic load, again increasing inflammation.
What are processed and ultra processed foods?
If a food has a long list of ingredients that you don’t recognise, particularly when many of the ingredients have chemical names, this will very likely be an ultra processed food. It is also worth looking at the ‘use by’ date. If the product doesn’t go off for two years, question why. If its shelf life has been prolonged through a natural process such as pickling, fermenting, curing or drying, this will not contribute to inflammation. But if, for example, it is a cake that doesn’t go off for two years, its shelf life is likely to have been prolonged by ultra processing, which may include removing fibre, and adding trans fats and other chemicals, which would contribute to gut damage and inflammation. Lastly, when considering ingredients, think about whether the whole food has been used, or whether parts have been removed. Where parts have been removed, the body may struggle to process it properly and it can contribute to inflammation.
As a general rule, the more pronounced and excessive the packaging, the more the food has been processed.
Allergenic foods
Any food can potentially be an allergen for an individual. An allergen is anything substance that triggers a certain inflammatory immune response from the body. Certain foods are more likely to produce inflammatory responses. By law, the top 14 allergenic foods must be highlighted within the ingredients list on food packaging so they are easy to spot.
Autoimmunity and allergenic foods
It is really important to stress here that these are not necessarily bad foods. Public health advice is usually polarised and reduced to a level where it has lost much of its value. We need to recover our ability to judge the effect of a food on us as an individual. Many of these top allergenic foods hold huge nutritional value and it is important to maintain a diverse diet for the health of the microbes in our gut, which are so influential over our immune system.
However, it is worth noting that gluten and dairy stand out from this list as they appear to trigger some level of inflammation in many people with autoimmunity. Let’s have a look at reasons for this:
Gluten
People with autoimmunity often already have significant inflammation in their bodies, which increases their risk of immune dysfunction and food intolerances. Gluten is a highly reactive protein and so would be one of the most likely foods for someone to react to.
There is a separate and important reason why removing gluten can also benefit some people with autoimmunity though. Gluten can trigger the body to release increased levels of a chemical called zonulin in some people. Excess zonulin can damage the tight junctions between the cells lining the gut wall, meaning that toxins and undigested foods can pass into the bloodstream, triggering an immune reaction and inflammation. The Western diet is heavily laden with gluten. Consequently many people will be weakening their gut wall multiple times per day, potentially contributing to significant inflammation. This is why some people find removing gluten completely from their diet helps.
Lastly it is worth being aware that having an autoimmune disease increases your chance of developing coeliacs disease, which is a specific immune reaction to gluten, and is highly inflammatory and damaging to the gut. Rheumatoid arthritis and Hashimoto’s in particular are linked to an additional increased risk of coeliacs. It is possible to test for coeliacs with your GP or privately, but you must have been eating gluten regularly for at least six weeks before the test.
Dairy
Much of the benefit of dairy used to come from the omega-3-rich grass eaten by the cow and passed through to the milk. Nowadays, cows are largely grain fed, with several chemicals added to the feed, meaning that the omega-3 benefits have largely been lost. Treating cows regularly with antibiotics is now common practice, so much of the milk in the UK carries an additional chemical burden which can promote inflammation.
Casein, the protein in milk, is one of the most allergenic proteins in foods, so some people will have developed an intolerance to it, particularly if they already have chronic inflammation.
Lastly, there is a specific gene that plays a key role in the digestion of lactose, the sugar in milk. In the UK around a third of us (worldwide two thirds) lose this genetic function at around five years of age, so for those people digesting milk becomes much harder. Certain gut microbes in a heathy gut microbiome can help to digest small amounts of lactose, so eating just small amounts of dairy may be manageable for these people. Fermented dairy products such as cheese and yoghurt contain less lactose, as this has been partially digested by bacteria as part of the fermentation process, so these may be more tolerable. It is worth noting that this only applies to traditionally fermented cheese and yoghurt, not ultra processed equivalents (eg Kraft slices, etc).
Food allergies and intolerances, coeliacs, and the genetic ability to digest lactose can all be tested through a registered nutritionist.
Alcohol
An individual’s ability to tolerate alcohol will vary widely. Many people with autoimmunity already have a high toxic load and find that reducing or removing alcohol can reduce their inflammation levels. Alcohol generally has a damaging effect on the gut microbes and so can also negatively impact immune tolerance.
Nightshades
Some people with autoimmunity, particularly Crohn’s and colitis, find they can react to nightshades (aubergine, potatoes, tomatoes, peppers), especially during a flare, so it can be of benefit to remove these short term. Some people find that removing the skins is sufficient. However, nightshades contain many compounds so important to health and immune tolerance that it is generally not advisable to cut them out completely in the longer term.
2) Foods that repair damage caused by inflammation
Antioxidants
Antioxidants significantly reduce inflammation. They do this by protecting tissues against damage from free radicals, which can be raised in people with autoimmunity. Plant foods are rich in antioxidants.
Just some of the many types of antioxidants that protect our tissues from inflammation damage
It is best to eat a wide array of differently coloured plant foods to maximise antioxidant protection, as foods from different antioxidant groups offer different types of protection. Nutritional testing can help you identify whether your levels are sufficient.
3) Foods that promote immune tolerance in autoimmunity
Promoting immune tolerance is one of the most effective ways of reducing excessive, chronic inflammation. Research shows that the microbes in our gut are hugely influential over our immune system and its ability to promote tolerance.
How food can alter our gut microbes
Microbes will take up residence anywhere in nature where there is moisture, warmth and food. This includes the lining of our guts. Over the past twenty years or so, our understanding of the influence of these microbes over our physical and mental function has grown enormously, yet we still only have part of the picture. What is clear is that we are super organisms, totally reliant on these microbes for certain vital functions. In fact, the case is growing that we should consider our microbes as one of our vital organs, just like our hearts, lungs, brain, liver and kidneys.
The foods that enter our guts massively influence which microbes grow there. Beneficial microbes form a protective layer over the cells of our gut wall, as well as providing fuel for new cell growth for gut wall repair. The better protected our gut wall is, the less likely it is to malfunction, resulting in inflammation. These microbes also synthesise certain vitamins for us, such as many of the B vitamins and vitamin K, which are needed by the immune system as part of its tolerance pathways. We also know that beneficial microbes help us to control our blood sugar levels, which reduces inflammation, as well as regulating mood, leading to better mental health.
So how do we use food to nourish these beneficial bacteria?
Increase fibre range
The most impactful thing we can do is to increase the range of plant fibres in our diet. Fibre is the food for our microbes and the more diverse the fibre we eat, the more diverse our microbes become. Here are just a few ideas for increasing the range of fibre in your diet:
Ideas for adding more diverse fibres to your diet
Add fermented foods
Fermented foods contain beneficial bacteria which can help to nourish the overall health of our microbes. Fermented foods include kimchi, sauerkraut, milk or water kefir, kombucha, fermented cheese and yoghurt (dairy or nut), miso, tempeh and natto. Many cultures will have their own lesser-known fermented foods as well. These are all wonderful to add into the diet, starting slowly and building up over time.
Reduce ultra processed foods, especially sugar
Ultra processed foods, which we looked at above, can significantly alter the ratio of beneficial to non-beneficial bacteria in our guts. Our beneficial bacteria feed on plant fibres, which are low to non-existent in many ultra processed foods. When we deprive our beneficial bacteria of fibre, they can’t survive. Certain chemicals in ultra processed foods are also damaging to these bacteria. When levels of beneficial bacteria in our guts are low, this allows opportunistic pathogenic bacteria and other parasites to take hold. Sugar feeds these non-beneficial microbes, allowing them to multiply and crowd out many species of beneficial bacteria.
Nutrients for immune function
Any nutritional excess or deficiency will ultimately impact the immune system and inflammation, however there are certain nutrients that the immune system is heavily reliant on in promoting tolerance, that can often be low in people with autoimmuinty.
Key nutrients for autoimmunity
Vitamin B6 is key nutrient, and is often low, particularly in women. Those with plant-based diets need to ensure they eat plenty of B6-rich foods, such as beans & lentils, avocado and parsley. Magnesium is low in the majority of the UK population, particularly women, yet it is vital to immune function, as well as to stress management. Vitamin D is also low in the majority of the population and research shows that optimising levels can help autoimmune conditions. The NHS advises 400 IU (10 mcg) per day over the winter. Vitamin A plays a crucial role in barrier function and is often found to be low in people with autoimmunity. Some people have gene-types that restrict their ability to convert beta-carotene from plants into usable vitamin A. Nutritional testing can really help identify where people need support.
Think about WHEN you eat
Leaving gaps in-between meals and overnight allows various processes to happen that promote a healthy gut barrier, key to maintaining immune tolerance and reducing inflammation. Research suggests that leaving 3-4 hours between meals and 12-16 hours overnight can make a huge difference.
Don’t forget about your blood sugar levels
Peaking and troughing blood sugar levels are extremely inflammatory. Our aim is to help any sugars (carbohydrates) in our food be released slowly over time to last until our next meal. We can do this by making sure each meal is a balanced combination of protein, beneficial fats and fibre, as well as carbohydrates. Refined carbohydrates (eg sugar, ultra processed breakfast cereals, bread, cakes, biscuits, etc) should be reduced as these sugars are released more quickly than in complex carbohydrates which are higher in fibre. When they are eaten, have them as part of a balanced meal. See ‘How can balancing your blood sugar help your autoimmune condition?’ for more information.
How do I use anti-inflammatory diets with my autoimmune clients in clinic?
The benefits of working with clients in clinic (remotely or in person) is that we test how these areas are functioning, whether it be the health of the gut microbes, presence of pathogens or parasites, levels of inflammation, nutritional excesses or deficiencies, detoxification capacity (which impacts inflammation), fatty acid or dietary fibre levels.
We also review their diet and their symptoms to expand the picture and gain an understanding of where we can intervene to benefit their health.
It can be difficult to gain an objective picture of our own diets, so I can often help clients by identifying certain blind spots that they are unaware of.
We also work together to come up with ways of eating that are enjoyable and satisfying as it is so important that we look forward to our meals as a time of respite and recovery.
Lastly we look at the phasing of our interventions. We don’t need to have perfect diets. We prioritise changes depending on individual’s needs. Some changes will just be temporary to help someone get out of a flare. The body’s needs are always changing and diets should never be fixed. They should be responsive to what the body needs at that particular time.
To find out more about what triggers autoimmunity, read ‘What is autoimmunity and how can natural diet and lifestyle changes help?’, or sign up to my monthly newsletter below.