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Autoimmune Disease

What is autoimmune disease?

Autoimmune diseases are family medical conditions where a person’s immune system attacks the body’s own tissues. There are at least 80 different autoimmune conditions. While the causes of autoimmune conditions are not fully understood, the incidence appears to be increasing in westernised societies around the world. Multiple sclerosis, type 1 diabetes, inflammatory bowel diseases (mainly Crohn’s disease), systemic lupus erythematosus, primary biliary cirrhosis, myasthenia gravis, autoimmune thyroiditis, hepatitis, and rheumatic diseases are some autoimmune conditions that have been shown to be steadily increasing in recent years.

The medical management of autoimmune conditions Can be a frustrating journey for many. Traditionally, patients are often told that lifestyle factors have little to no impact on the progression of their condition, leaving them with limited options other than medications to manage their symptoms. The influence of the pharmaceutical industry has led to a heavy reliance on immune-modifying therapies to suppress or blunt the inflammatory activity of the immune system. Unfortunately, these types of medications come with serious trade-offs, including a compromised immune system, nutrient deficiencies, and liver damage. That is not to say there isn’t a place for medications in the management of autoimmune or chronic inflammatory conditions. However, recognising that autoimmune conditions may be with a person for life, lifestyle strategies take an important seat in improving symptoms mitigating the progression of autoimmune conditions. Looking at diet and lifestyle is about using all the tools at one’s expense to reduce inflammation and support overall health.

Diet and inflammation

Nutrition and immunity are closely related. First, the immune system is made up of the highest energy-consuming cells that require a range of micronutrients and protein to function. Secondly, much of the immune system is located in the gut lining; a part of its role is surveying the contents of the gut, including components from the diet as well as microbial species.

Mounting evidence has made it clear that westernised diets and lifestyles negatively affect the gut and immune system and are associated with an increasing rate of autoimmune disorders worldwide. Although much progress has been made with research into autoimmune disease, there still isn’t one clear mechanism to point to why autoimmune disease develops in some people. Some elements that are thought to likely play a role in the development of autoimmune disease are: 

  • Intestinal hyperpermeability
  • Industrially processed food additives, such as emulsifiers
  • Infection
  • Chemicals or other compounds capable of modulating immune responses such as occupational/environmental pollutants or drugs
  • Smoking
  • Ultra-processed foods and "westernised" diets

Intestinal permeability ("leaky gut") and chronic inflammation

Changes to the intestinal barrier function are believed to be central in the pathophysiology of autoimmune disease. This process is commonly known as leaky gut. In the “leaky gut” syndrome, food ingredients or certain chemical components may lead to the activation on an [auto]immune response. Gut lining and immune dysfunction may then continue to worsen due to bacterial imbalances and consumption of ultra-processed inflammatory foods. These changes caused by a leaky gut promote a state of low-grade chronic inflammation. Gut lining dysfunction can also lead to the development of multiple food and chemical sensitivities which can make it incredibly difficult to identify the best dietary approach.

Whole-food anti-inflammatory diet

Whilst autoimmunity is complex and influenced by a range of factors, the first place to start with nutrition is to choose an anti-inflammatory diet that minimises ultra-processed “westernised” foods. An anti-inflammatory way of eating aims to include plenty of minimally processed whole-foods that are rich in micronutrients and antioxidants.

Foods to include in your diet to reduce inflammation:

  • Vegetables: Aim to include vegetables in at least two meals or at least four cups per day. Dark green leafy vegetables are especially rich in vitamins, minerals and protective plant compounds.
  • Fruit: All fruits provide unique health-promoting properties. Dark berries such as blackcurrants are especially rich sources of polyphenols that support gut health and inflammation.
  • Herbs and spices: Pungent herbs and spices such as thyme, rosemary, turmeric, ginger, and cumin contain various unique plant compounds with anti-inflammatory properties.
  • Healthy fats: Olive oil, hemp seed, avocado oil, nuts and seeds all provide anti-inflammatory fats and antioxidants.
  • Animal protein sources: Meat, fish, chicken, and eggs all carry many essential vitamins and minerals. Eating enough protein is important for stabilising blood sugar levels to support a healthy adrenal response.

Ultra-processed foods to minimise in the diet to reduce inflammation:

  • Refined sugar in all forms. It can be surprising the number of usual household food items that contain sugar.
  • Processed snack foods: Chips, crackers, muesli bars, breakfast cereals, coffee sachets
  • Industrially processed seed oils: Canola, soybean, vegetable oils.
  • Refined carbohydrate foods: Commercially processed bread, wraps, breakfast cereals, crackers.
  • Alcohol.
Changes to the intestinal barrier function are believed to be central in the pathophysiology of autoimmune disease. This process is commonly known as leaky gut. In the “leaky gut” syndrome, food ingredients or certain chemical components may lead to the activation on an [auto]immune response. Gut lining and immune dysfunction may then continue to worsen due to bacterial imbalances and consumption of ultra-processed inflammatory foods. These changes caused by a leaky gut promote a state of low-grade chronic inflammation. Gut lining dysfunction can also lead to the development of multiple food and chemical sensitivities which can make it incredibly difficult to identify the best dietary approach.

Autoimmune disease and food intolerances

Changes in the intestinal barrier (leaky gut) and dysbiosis are believed to be central in the development of autoimmune diseases. These changes in the gut can also mean that food intolerances may contribute to low-grade chronic inflammation and the aggravation of autoimmune processes.

Dietary antigen-mediated autoimmunity is well-recognised in coeliac disease and non-coeliac gluten sensitivity. In these conditions, gluten is the dietary antigen (a specific type of protein) that leads to the mounting of an auto-inflammatory response. Dietary intolerances can be present in other autoimmune diseases when disrupted gut health leads to the immune system producing immunoglobulins in response to various otherwise healthy foods. Some common food intolerances that might be present in individuals with intestinal hyperpermeability and dysbiosis include:
  • Gluten
  • Grains
  • Dairy
  • Soy
  • Eggs (especially whites)
  • Certain nuts or seeds
  • Nightshade family produce (potato, tomatoes, eggplants, capsicum, cayenne, chilli)
  • Emulsifiers, thickeners, and other food additives

It is important to note that when it comes to food intolerances, everyone’s experience is very personal. Sometimes the pursuit of avoiding many foods and following a strict elimination protocol can create excess stress that outweighs the benefit. In these situations, it is often helpful to meet with a nutrition professional with experience with autoimmune disease and gut health to develop a personalised approach that’s right for you.

Stress and autoimmune connection

Overall stress sits in the centre of how well our bodies can adapt to any health issue. Indeed, stress is a central driver of many chronic inflammatory issues seen in westernised societies. Stress kills. This is where looking at diet in isolation has its limitations. Addressing autoimmune conditions from a holistic standpoint is also about the environmental context through which we go bout life. Inflammation is triggered by getting inadequate nutrition, feeling stressed, a lack of restful sleep, and overtraining. Chronic stress and overtraining also increase intestinal permeability, which fuels the cycle of food intolerances, dysbiosis, and further low-grade chronic inflammation. The beauty here is that there are many lifestyle-based strategies that can be used to mitigate stress. Addressing these core areas are also powerful tools for reducing inflammation in the body.

Lifestyle factors for alleviating inflammation:
  • Sleep: Get at least 8 hours every night
  • Mindfulness strategies such as meditation
  • Restorative breathing techniques
  • Protecting circadian rhythms: Being out in daylight and avoiding bright lights in the evening
  • Spending time in nature and with animals
  • Nurturing social connections, laughing, and intimacy
  • Exercise: Moderate intensity activity and having appropriate rest from high-intensity training.

Autoimmune conditions are becoming an increasingly serious public health issue. With limited medical strategies to mitigate the progression of various autoimmune conditions, patients might easily feel stuck on a casserole of pharmaceutical therapies. Since nutrition is so closely related to the health and function of the immune system, many aspects of diet and lifestyle can be modified to support inflammation and improve overall well-being for those living with autoimmune conditions.

References:
https://pubmed.ncbi.nlm.nih.gov/16265432/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8620243/
https://doi.org/10.1016/j.autrev.2011.10.022