Autoimmune Diet with Nutritionist Jill Brook

Nutrition for Autoimmunity - Full Episode Mike Brook: [00:00:00] Hello POTS patients and all you fine people out there who care about POTS patients like I do. I'm your occasional host, Mike Brook, and this is an episode of the POTS Practitioners where we're going to talk about nutrition strategies to fight autoimmunity. We'll be talking today with your usual host and my always wife, Jill Brook. Jill is a longtime nutritionist in California. She holds degrees from Princeton University, UCLA, and the Central Wisconsin Institute of Acrobatics and Cheese. She's nutrition consultant to Dysautonomia Clinic, research liaison to Standing Up to POTS. And she's a POTS patient herself, with enough autoimmune conditions that she tracks her flares on a wall sized calendar. Welcome Jill! Jill Brook: That part's not actually true but thank you. And thank you for hosting. [00:01:00] Mike Brook: So this topic has been requested several times by listeners especially after episode 67 where you talked to Dr Cathy Pederson about the basics of autoimmunity. Now before we get started can you remind us what is autoimmunity and why it matters for POTS? Jill Brook: Sure. Autoimmunity is when the body's immune system attacks some of its own healthy tissue. There are over a hundred or more different autoimmune conditions defined by which type of tissue is being attacked. A person can unfortunately have more than one autoimmune condition at once, and research finds that POTS patients have higher rates of autoimmunity then the general population. And some research suggests that POTS itself might even have an autoimmune basis in some cases. Mike Brook: Aha. Okay, I'm gonna out you to our listeners for a second. In case you don't know, Jill is a list maker and so she arrived today for the podcast with a list [00:02:00] of 10 nutrition strategies for fighting autoimmunity which we will get to in a moment. But before then can you paint the big picture for us here. What themes are we gonna be looking at today when it comes to fighting autoimmunity? Jill Brook: Sure. I think the main theme is just doing all sorts of different things to try to stop chronic inflammation. So balancing blood sugar and insulin, avoiding ingredients or toxins that are known to promote inflammation or autoimmunity, and figuring out if there are some specific foods or ingredients that are normal healthy foods for almost everybody but might be triggering your immune system. And I'd say that around 80% of an autoimmune or anti-inflammatory diet is just eating real unprocessed like actual quality food the way that nature intended instead of the standard Western American diet, that's full of ultra processed foods and chemicals and things that the [00:03:00] body and the gut microbiome don't actually recognize as food. So that gets you pretty far but then there's just a few additional strategies or nuances. Mike Brook: Okay, so I'm gonna say what we say frequently at this point in the program which is that this is not medical or dietary advice. This is just informational and that people should consult their own doctors. But how strong is the research for all this, for fighting autoimmunity with diet? Jill Brook: Well there are a few one-off studies showing that for example a vegan diet or a vegetarian diet or paleo diet or paleo autoimmune protocol diet helped patients with some particular autoimmune disease or another. And usually it was compared to the standard American diet, and we know that pretty much any diet looks amazing compared to the standard American diet. So it's kind of hard to find a great deal of first rate evidence that definitively says [00:04:00] what is the best diet for all autoimmune conditions. There's never enough research with actual humans going about their everyday lives because that's so expensive and people aren't very accurate when they report their diets anyway. So I'm gonna be discussing what I think is the reigning theory of autoimmune nutrition, which is based on a whole lot of studies about inflammation, some studies in animals, studies about what happens to gut microbes, and a lot of that has been put together by some very smart people to form some principles that are pretty widely accepted. And it's all considered healthy stuff anyway, so it's not like it's way out their strategies. It's mostly finding ways to do more of what nature intended since inflammation and autoimmunity seem to be on the rise in response to more modern diets and exposure to chemicals ,toxins and stuff like that. Mike Brook: Okay so real whole foods are [00:05:00] anti-inflammatory and they help balance blood sugar, they don't contain as many chemicals or toxins, they promote good gut health. So that would be the reason that we would want to stick to that kind of a diet. Jill Brook: yep exactly Mike Brook: Okay. So if anyone doesn't remember why gut health is important to inflammation or autoimmunity they can go back and listen to episode 58 because that is so important we dedicated an entire episode to it. Jill Brook: Right. Mike Brook: Okay So let's get into specifics. Let's start with number one. What is the first nutrition strategy thought to help fight auto immunity? Jill Brook: Well for the first three strategies I'm gonna reiterate what we said in the gut health episode. Mike Brook: So again episode 58, and we talked about how the diversity of the gut microbiome and the permeability of the intestinal barrier have a lot of influence over the immune system. If anyone doesn't know what we mean by gut health or if you're a German speaker gut health, they [00:06:00] might want to listen to that episode after this one. Jill Brook: Right right. That's really important. So the first autoimmune strategy is to avoid consuming things that disturb the healthy gut microbiome such as excess sugar, Nutrisweet, Splenda, industrial additives and preservatives, unnecessary antibiotics or excessive pesticides when possible. And then alcohol, although I don't know a single POTS patient who even could drink the four plus drinks a day that it would take to drink too much alcohol, but those are the things that can really disturb the gut microbiome. Mike Brook: Okay. And they could either do that by harming the friendly microbes or encouraging the unfriendly microbes. So it basically comes down to avoiding junk food, processed food, fast food, sweets, alcohol and, if possible, getting meats and dairy raised without antibiotics. Is that right? Jill Brook: [00:07:00] Yep. Yep. And then strategy number two is the flip side: it's to eat foods that really nourish the friendly microbes especially trying to eat the widest possible variety of whole plant foods like fruits, veggies, whole intact grains, legumes, nuts, seeds, herbs, the widest variety that you can tolerate or have access to because variety matters more than absolute quantity. You could also eat some probiotic foods like sauerkraut or kimchi to get the probiotic microbes directly. But the wider dietary variety is the key, especially from plant foods with fiber, because that gives you more microbial diversity, which is related to better health in a lot of different ways, including a calmer more effective immune system. Mike Brook: So this is what I love about the POTScast, Jill. Now my life is starting to make a lot more [00:08:00] sense. I am frequently finding additional greens, nuts, and seeds in my food. And now it it makes me realize you are the one that's been putting them there. Jill Brook: Yeah I just want you to be healthy. I like to play a game with myself and you, which hopefully is not too annoying, to attempt to eat the rainbow as often as possible, to get a food from every color, to get a food from every different family of plant foods, and also eat every different plant part as often as possible. Mike Brook: What do you mean by plant part? Jill Brook: Like leaves, shoots, stems, roots, fruits, seeds, like different parts of plant anatomy. Mike Brook: Okay. And then when you say plant family what do you mean by that? Jill Brook: Well like for example in the vegetables there's the cruciferous family, that's the broccoli, cauliflower, brussel sprouts, cabbage. There's the onion family, the leafy green family, the squash family, there's the mushroom family. Within fruits, there's the berry [00:09:00] family, the stone fruits, the melons. Like all the different botanical families. Because the thinking is that every different family of plants helps support different species of friendly gut microbes. And again the variety, the diversity of those microbes is what's affiliated with so much improved health. Mike Brook: Okay. So the leafy greens, the squash family, and the stone fruits. I feel like I'm at a folk rock festival right now. Let's go onto number three. Jill Brook: Okay that one is trying one to four months gluten free to decrease intestinal permeability. Mike Brook: Okay. So we've talked about this before but you've said that gluten, I think I got this right, gluten signals the intestinal barrier to become more permeable and you have described how more of whatever is in your intestines can then get through that barrier and into your bloodstream. And that's when it could start to trigger an immune response. Jill Brook: Yep. And that goes for everybody [00:10:00] having the increased intestinal permeability not just people with celiac disease, for example. And at the Dysautonomia Clinic we published a paper last year reporting that some POTS patients feel enormously better without gluten with their autonomic scores improving and self-reported POTS symptoms improving a lot. Mike Brook: So before we move on, we have a question from a listener. So this is from Ally. So thank you Ally for sending this in. And Ally seems to be a real overachiever. So she asks, does less than one gram of cane sugar on a label constitute enough sugar to be unhealthy for gut health, or how much is too much? Jill Brook: So POTS patients are all overachievers. You should know that by now. But no I cannot imagine a world where under a gram of sugar makes a difference for gut health or for blood sugar spikes, which we also want to avoid for fighting autoimmunity. But just to put it in perspective, according to the USDA's 2016 [00:11:00] data, the average American consumes 17 teaspoons every day of added sugar. That's the equivalent of two and a half cans of Coke. It adds up to 57 pounds of added sugar per year. So for all the POTSie overachievers out there I don't think we need to worry about the one gram. That's practically nothing. Mike Brook: Okay. So is there an amount of sugar that is okay? Jill Brook: Well the US dietary guidelines would recommend limiting total sugar intake, added sugar intake, to 10% of calories or less. So that works out to be like six teaspoons a day for women or nine teaspoons a day for men. As you know, I don't think the USDA really has the highest standards for our health. So the autoimmune diet or a gut healthy diet would challenge you to get even lower on added sugar, but there's not an exact number. You kind of just wanna go as low as you need to see [00:12:00] results. Just do your best, I mean sugar's addictive. Mike Brook: So that was a very diplomatic way to describe your relationship to the USDA. So yeah so we we talked about strategies to kick the sugar habit in our gut health episode. So people could look back and listen to that one and it's right toward the end of the episode. But let's get back to your list. So what have we got what's number four? Jill Brook: Get vitamin D levels up if they're low. Studies show that blood levels of about 40 to 50 nanograms per milliliter are associated with lower rates of some autoimmune conditions. Vitamin D is known to reduce inflammation in numerous different ways, including affecting the expression of like over a thousand genes. And a really big nice study at Harvard recently reported that taking two 2000 IU vitamin D3 daily reduced onset of new autoimmune conditions in older people by over 20%. [00:13:00] Mike Brook: Okay. So why don't you describe for us a little bit about that study and why you think it's important. Jill Brook: Well this was a good study because it was big, it was randomized, placebo controlled. It included about 25,000 subjects followed over five years and they were sent either real vitamin D pills or a placebo to take daily. And then they watched for new diagnoses of autoimmune disease over five years. And it's kind of rare to see studies that are so big and that last so long with real world dependent variables like actual diagnoses of autoimmunity. Mike Brook: Okay. So if I wanna do this how would I increase my vitamin D? Can I eat it? Do I have to get sun? Is there a supplement? What do I do? Jill Brook: So you can get your blood levels tested, and if your doctor doesn't test vitamin D there's a citizen science project led by some top experts called Grassrootshealth.net where you can sign up to get your vitamin D tested [00:14:00] every six months at a discounted rate. And then you can also fill out their survey and they collect data. They also have a vitamin D calculator where you can put in your current blood levels your desired blood levels, your body mass index, and it'll suggest the dose of vitamin D to take. And you probably will not get enough from food. Very few people can get enough from food, like people only on diets of Alaska natives for example. And very few people can get enough vitamin D from sunshine. There is an app called Vitamin D Minder that can tell you how much vitamin D you're getting, and if you're getting enough based on your latitude and some other information that you put in, but most people would have to take supplements. Mike Brook: And just to remind everybody you did an entire episode on vitamin D. It was episode 91. You talked vitamin D and autoimmunity with Dr Eduardo Beltran in that episode. Jill Brook: Yeah. And he reports that some autoimmune patients [00:15:00] have genetic variants that make them unable to process vitamin D effectively. So that's just one more angle you can learn about in that episode. He's a fan of larger doses of vitamin D if you have those genetics and can monitor for toxicity with your doctor. Mike Brook: All right, great. So what's the next strategy? Jill Brook: Number five, avoid consuming so much plastic. Mike Brook: Well that's gonna be tough for me. I just love a nice plastic in the morning. Jill Brook: I realize that you're not trying to eat it but the average American consumes about a credit card worth of plastic every week from plastic bottles, heating food in plastic containers, drinking hot liquids from disposable cups lined with plastic, some canned foods have plastic lining, acidic foods in plastic bottles can leech out some plastic. And there's some research by Dr Datis Karazian and others showing that chemicals in plastic can disturb our [00:16:00] hormones, our metabolism, they can increase cancer risk, but that they also appear to really promote autoimmunity. Mike Brook: So if I don't even know I'm eating this how do I avoid it? Jill Brook: Well it's probably not possible to avoid all plastics but you could do things like get a glass or stainless steel water bottle instead of a soft plastic one, get powdered sports drinks and mix them in your own container so that you're not buying acidic drinks that have been sitting in plastic a long time. You could get glass storage containers so that you never heat up food on plastic. I try to buy things like vinegar or acidic foods in glass jars instead of plastic. So things like that. Mike Brook: Okay. So I'm just gonna warn you I'm gonna use one of your trigger words now, Jill. BPA free. Tell me about BPA free things. Jill Brook: Well yeah, a lot of plastic containers now have the BPA [00:17:00] free symbol on them showing that they are free of the nasty plastic byproduct that is associated with all of these health problems, but they just replaced it with a bunch of other bisphenols like bisphenol B through Z instead of using A. And the research on those unfortunately is showing that the BPA substitute appear even actually worse than BPA, it's just that people don't know it yet, so they're getting away with putting them in all these products. Mike Brook: Yeah, that's an old trick isn't it? Let's look at number six. What's the number six strategy? Jill Brook: So we already mentioned going gluten free for one to four months. And if you noticed that that helped you feel better, then a trial going dairy free might also be worth it, because the dairy proteins are similar to the wheat proteins. Mike Brook: So this is something you would try and then you'd kind of monitor to see if it helps and if it does maybe keep doing it, and if not would you just go back to eating what you were eating before? Jill Brook: Yep. Just [00:18:00] trial and error. And dairy raised without antibiotics might also help because it might be better for gut microbes since those antibiotics kill the good microbes as well as the bad ones. Mike Brook: So does this go for all dairy? I mean what about more exotic ones like sheep and goat? And I think there's Jersey cows produce something called A2 dairy and then there's of course lactose free. What about all those? Are those better or the same or what? Jill Brook: Yeah. So if conventional cow dairy is causing a person inflammation trying those other types might work for them. So the grass fed, the lactose free, the sheep or the goat, the A2 dairy from the Jersey cows, for example, they might find - again it's just trial and error - that one of those dairies might not cause them the inflammation that the conventional dairy is causing them. Mike Brook: Okay. So you said to try this if going gluten-free helps because the proteins are similar, but would this be something you might try even if going gluten free didn't [00:19:00] help? Jill Brook: Yeah. Absolutely. Especially if you're having trouble figuring out how to turn off your inflammation it's probably worth a try. Mike Brook: Okay. All right let's move on to the next one. Jill Brook: Okay. Number seven is to eat a good balance of omega three fatty acids versus omega six fatty acids. Mike Brook: Okay, and just remind us. I think people are getting too many 6's and not enough 3's. Is that right? Jill Brook: Exactly. So the omega 3's are the healthy and anti-inflammatory fats found in things like wild Alaska salmon and other wild caught cold water fatty fish like sardines and anchovies. They're also in flax seeds and walnuts, although it's not nearly as usable when it comes from plant foods. Some people take supplements for omega 3's like fish oil or krill oil but, those don't get the amazing research findings we would expect when they're really put to the test. So that's kind of disappointing, but omega-3 supplements [00:20:00] are an option. You would ideally use ones that do not smell like fish cuz that could mean they're rancid. And you want ones that are third party tested for things like mercury or heavy metals. Those might be better. And some people, like the researchers at NutritionFacts.org really recommend the omega-3 supplements from algae instead of from the ocean because then you don't worry about all the ocean contaminants. But again I haven't seen any great actual studies comparing different types of omega-3. There is a really big study showing that having low omega 3's versus high omega 3's affects longevity, the same effect size as smoking versus not smoking. So that appears to be a really big deal. But unfortunately that same Harvard study that looked at vitamin D supplements affecting autoimmune diagnoses over five years, they also looked at omega-3 [00:21:00] supplements and didn't really find any like big amazing results from it. So if I could stand fish and had an infinite budget for wild Alaskan fish I would definitely choose to get my omega 3's from real seafood. Mike Brook: And when you say if you could stand fish, the main issue you're talking about is is histamines I think right? So the the difficulty of getting seafood fresh enough to be low histamine. And I've seen you try a whole bunch of things here. A little canister of salmon eggs for a while, that was in our refrigerator. Jill Brook: Yeah. Yeah, so there is a company called Vital Choice seafood that claims to freeze their fish right upon catch. And so those are a thought to maybe be low histamine options for people. But I was pretty repulsed and I struggled with it. I was a coward basically, so I went back to omega three supplements which I know [00:22:00] are inferior. I'm not proud of that. Mike Brook: Yeah. You circled that canister for a few months as I recall, but you eventually lost the fight. But can you say a little bit more about this sort of ratio between the threes and the sixes? Jill Brook: Oh right. So, you want the higher ratio of omega 3's to omega 6's, and omega 6 fatty acids are not unhealthy but if we get too many of them then they promote inflammation. So those omega six fatty acids are mostly found in vegetable oils or seed oils like corn oils, soybean oil, safflower oil. So they end up in processed things like potato chips or processed snack foods. Mike Brook: So our rule of thumb of avoiding these processed foods comes into play once again. Jill Brook: Yep Mike Brook: Okay. What's the next strategy? Jill Brook: Number eight is to use cooking methods that are less inflammatory like steaming, boiling, poaching, lightly sauteing, [00:23:00] or anything that uses more moisture or lower temperatures. Mike Brook: So as opposed to what? What would be the inflammatory cooking methods? Jill Brook: Frying or any method that uses really high and dry heat is more inflammatory, especially if it produces brown or charred bits on your meat. Also oils heated beyond the smoke point are thought to be inflammatory. Mike Brook: What's next? What's the next strategy? Jill Brook: If eating clean and avoiding known inflammatory foods isn't helping enough and someone's still having chronic inflammation, then they might think about doing some elimination diet trials to test whether a normal typically healthy food is for some reason a trigger for them. Mike Brook: So this would mean identifying your personal food triggers and these are gonna be different for everybody I assume. But what are some common ones? Jill Brook: The most common ones are things like shellfish, eggs, soy, wheat, [00:24:00] corn, dairy, grains, legumes, nuts, nightshade vegetables... Mike Brook: Say what nightshades are please. Jill Brook: That's the family of vegetables and some fruits. It's potatoes, tomatoes, peppers, egg plants, goji berries, and a few others. Mike Brook: So is this just a trial and error thing where you try and see if you feel different remove something add something? Is that the methodology? Jill Brook: Yeah. So that's one way to do it. You can remove a food for a month and see if you feel any different. And that's a great method insofar as it doesn't get too restrictive to just avoid one food at a time. But for people who are like all inflamed all the time in a flare and wanna just feel better ASAP, they might not feel better when they just remove a single food. They might have to try something more strict and more regimented. Mike Brook: So I think I've heard you talk about this. Typical way that this is called is the Autoimmune Paleo [00:25:00] Protocol. Is that right? Jill Brook: Yeah, that's a popular one and it is very restrictive. But a temporary elimination diet that can guide people through this phase where they strip away pretty much every possible triggering food for about three weeks, hope that you feel much better by then that you know a lot of your inflammation and flare goes away, and then you can reintroduce foods one by one to see which foods are causing the flares. Mike Brook: So what would you remove during those 3 weeks? Jill Brook: Yeah so it's pretty restrictive because it's trying to avoid basically anything that could be the culprit. So it removes sugar, processed food, dairy, eggs, gluten, actually all grains, nuts, seeds, legumes, nightshades, shellfish... Mike Brook: So what does that leave you with, broccoli pretty much? Jill Brook: Kind of. It's it's really restrictive. [00:26:00] During those three weeks the common meals might be things like chicken, broccoli, and a sweet potato, or steak, asparagus, and yams, or turkey, cauliflower, cooked carrots, soups, stews, stir fries, salads, basically revolving around high quality animal protein, but not the shellfish, not the eggs, all sorts of vegetables, some fruit, root vegetables for starches, fresh herbs for flavoring. And another downside is as people are probably realizing it's it's kind of a lot of cooking. Mike Brook: Yeah. So we should probably mention at this point that people should consult a professional before getting too restrictive though you know. This is a bit playing with fire. You could definitely lead to nutrition deficiencies or in susceptible people, this could maybe trigger some sort of an eating disorder. Jill Brook: Yeah thanks for bringing that up. Food restriction should only be done very briefly and strategically with [00:27:00] some really good guidance to make sure you don't get malnourished and that you are guaranteed to learn something valuable from it. And then reintroduce foods as quickly as possible to get back to that diversity. Mike Brook: So if you're on the Autoimmune Paleo Protocol for three years you're probably doing it wrong. Jill Brook: Yeah. It's supposed to be just a brief elimination phase and then working back toward optimal diversity. Mike Brook: Okay. So we have another listener question and this one is about fasting. So we've heard about it, talked about it, and I think there's probably a lot of ways to do it, but maybe you can just say what is it, what are the best ways to do it. Could it possibly help with autoimmunity? And is it something you can even do if you have POTS? Jill Brook: Those are such good questions that we're gonna leave it to its own episode that we're working on all about fasting. But in general yes you can starve [00:28:00] inflammation. The problem is that you can't starve it indefinitely because then you also starve yourself. Fasting also makes it more difficult to stay hydrated and to balance blood sugar. And it does put you in more of a sympathetic state. That's the state of fight or flight which POTS patients often already have too much of generally. So there's definitely some complexities to worry about. And that's before you factor in things like medication which can be absorbed differently depending on whether you're fasting or eating. So I wouldn't recommend dabbling with it unless you have a doctor supervising it and recommending it. But there are some newer ways of fasting like time restricted feeding or the fast mimicking diet, that try to give you most of the benefits of fasting with less of the suffering or less of the risks. So we'll get all into that in our [00:29:00] fasting episode. Mike Brook: Okay. So everybody, fasting episode is on its way and to reiterate probably not something to dabble with unless you're in discussion with your doctor. So maybe not a first line strategy to try right? Jill Brook: Yep Mike Brook: Okay. So let's get back to the strategies. Do you have any more nutrition strategies for fighting autoimmunity? Jill Brook: No, but there are some lifestyle strategies to mention, which won't surprise anyone but they're just things like sleeping as well as possible, managing stress, trying to avoid smoking or secondhand smoke, trying to limit exposure to toxic substances or toxic mold, trying to avoid letting any lingering infections fester that might get your immune system all riled up. And that kind of thing. Mike Brook: All right. So we have covered a lot here and it might be a little bit overwhelming in fact. So what would you say to somebody who feels that they might want to try a nutrition [00:30:00] approach to fighting autoimmunity and it could be really helpful but where would you start? Jill Brook: Well, for starters they could just get a non-plastic water bottle, or start eating a slightly wider diversity of real whole unprocessed foods. Like even just a couple bites per day is enough for those gut microbes. And sometimes focusing on what to eat more of helps you eat less of the junky processed or sugary stuff too, without even trying, because then you don't have room for it anymore. Mike Brook: All right, so let's talk about resources and references. Are there really good websites and books that you recommend for people that might want to dig a little deeper on this? Jill Brook: Yeah. There's a lot of great resources. An autoimmune nutrition plan can be pretty involved so it's great to either have professional help or at least a reliable guide and maybe a book or an online community. So people who have free resources online [00:31:00] that I really like are Dr Terry Walls of the Walls Protocol, Dr Datis Karazian, and Dr Sarah Ballantyne. If you Google any of those you'll find great resources. Mike Brook: All right. So I'm guessing some people are probably wondering how effective something like this can be at fighting autoimmunity. So can we cure autoimmune conditions this way? Jill Brook: I think like everything in POTS, people see vastly different results. Some are helped hugely just doing a couple small things, other people less so. I don't think there is such a thing as curing an autoimmune condition, just putting it in remission, hopefully for a good long time. But the good news about all of these strategies is that they are healthy anyway. So if you consume less sugar or plastic or more whole foods and it does not help your autoimmunity at least it was doing some other good stuff for you. Mike Brook: I think that's a good note to end on, and it's [00:32:00] lunchtime here. It's gonna be vegetables for me, Jill. I think probably for you as well. I got some carrots, broccoli, and kale on the menu. Jill Brook: Awesome. Mike Brook: Jill, thank you for all this great information. And hey listeners that's it for this episode. We hope you enjoyed this discussion. We will be back next week. And until then thanks for listening, remember you are not alone, and please join us again very soon.