The 4 Best Diets to Try If You Have an Autoimmune Disease
If you have an autoimmune disease like celiac disease, Crohn's, or rheumatoid arthritis, eating or avoiding certain foods really can make a difference in your symptoms.
There is, however, some research to suggest that certain foods may benefit people with an autoimmune condition, which occurs when your immune system mistakenly attacks your own body.
“In general, most autoimmune diseases show a response to some changes in diet, whether [the disease is] Hashimoto’s, rheumatoid arthritis, celiac disease, or Crohn’s,” says Sonya Angelone, RDN, a spokesperson for the Academy of Nutrition and Dietetics and a nutritionist in private practice in the San Francisco Bay Area.
Although there are common threads to so-called autoimmune diets (for example, most include anti-inflammatory foods), specific dietary changes need to be tailored to the person.
“There will be generalizations that always require individualization,” says Alicia Romano, RD a clinical registered dietitian at the Frances Stern Nutrition Center at Tufts Medical Center in Boston.
Here’s a snapshot of some of the more popular autoimmune diets, what they are, and what we know about them.
The autoimmune protocol diet (AIP)
Best for: IBD
Sometimes also called the Paleo autoimmune protocol diet, the AIP is an extreme version of the popular Paleo diet, which advocates a return to the types of foods our Paleolithic ancestors ate.
Foods to potentially avoid include grains, legumes, dairy, processed foods, refined sugars, industrial seed oils, eggs, nuts, seeds, nightshade vegetables, gum, alternative sweeteners, emulsifiers, and food thickeners, says Romano.
The AIP follows an elimination protocol where different food groups that might contribute to inflammation are taken out of the diet, then slowly added back in.
“We don’t have a reliable marker or test [for which foods are best], so we have to work with the patient, starting with the cleanest diet and slowly adding things back,” says Zhaoping Li, MD, PhD, professor of medicine and director of the Center for Human Nutrition at UCLA’s David Geffen School of Medicine of elimination diets in general. “Everyone is different. We have to live and learn.”
There’s no standard about how to actually implement these elimination protocols–and some protocols are Draconian, pulling out multiple food groups at one time, says Romano.
Such a restrictive approach may not be helpful for all people with autoimmune diseases, who, as a group, tend to be at risk for nutritional deficiencies and malnutrition, Romano cautions. But at least one study showed that for folks with inflammatory bowel disease or IBD–thought to be autoimmune or at least immune-related–this type of diet specifically reduced markers of inflammation in the gut. That inflammation is a hallmark of both Crohn’s disease and ulcerative colitis, the two conditions that make up IBD.
The anti-inflammatory diet
Best for: Rheumatoid arthritis
This diet is similar to the much-touted Mediterranean diet, which has been shown to lower the risk of chronic disease, extend lifespan, and reduce the symptoms of some autoimmune diseases like rheumatoid arthritis. The focus is on anti-inflammatory foods like fish, olive oil, fruits, vegetables, legumes, nuts, and seeds.
Foods should be as natural as possible, such as ocean-caught fish, Dr. Li says. And homemade meals are even better, because then you know all the ingredients that have been used.
Some people also find dairy to be problematic. “I would recommend limiting dairy to start. It can be added in later on,” says Dr. Li. Some people with autoimmune diseases may react to lactose, a sugar in dairy products, or proteins in dairy, Angelone adds.
A plant-based diet
Best for: All around
There is evidence that plant-based diets can benefit people with autoimmune diseases. Plus, both the AIP and anti-inflammatory diets also focus strongly on fruits and vegetables.
If you have an autoimmune disease, you might find you tolerate vegetables better when they’re cooked, though. “Large molecules can provoke the immune system, but when you’re cooking you’re breaking the molecules down,” explains Dr. Li.
A gluten-free diet
Best for: Celiac disease
Gluten is the name for proteins in wheat, rye, and barley, and it damages the small intestine of people with celiac disease, another autoimmune condition. “Gluten is [another] large molecule that can provoke an immune response,” says Dr. Li.
The only way to manage celiac disease is to avoid gluten, which is found not just in bread, but also pasta, soups, sauces, salad dressing, and a range of other products.
Because many people with celiac disease also have other autoimmune diseases, going gluten-free may benefit others as well. “I have found that more people [in addition to those with celiac disease] do well without gluten,” says Angelone. One small recent study found benefits to a gluten-free diet in women with autoimmune thyroid issues, for example.
In some cases, Romano says, simply improving the overall quality of someone’s diet might help. Then, “if patients have a strong suspicion that foods may be triggers, I will typically have them keep food and symptom logs, so we can get a better idea of patterns,” she says.
While the “best” autoimmune diet will be different for each patient, she says, “the patients that are willing to take the time to investigate their symptoms and improve their overall diet quality seem to do the best.”
“Lots of time people use the terms 'autoimmune' or 'anti-inflammatory' diets to mean lots of different things with a varying degree on how restrictive the diet is,” adds Kathryn Fitzgerald, ScD, of Johns Hopkins University, and a former National Multiple Sclerosis Society fellow. “However, a lot of the time there are many aspects of these diets that are common to a generally healthy diet like high intakes of fruits and vegetables and low intake of processed food. It may be that these aspects are the critical component rather than adhering to stricter dietary protocol.”
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