How nutrition and working with a qualified nutritionist can positively impact living with an autoimmune condition.

Autoimmune conditions, such as type 1 diabetes mellitus (T1DM), rheumatoid arthritis (RA), inflammatory bowel disease (IBD), systemic lupus erythematosus (SLE), multiple sclerosis (MS), thyroid disorders (Hashimoto’s thyroiditis and Graves’ disease), and coeliac disease, occur when the immune system mistakenly attacks the body’s own tissues. These conditions can lead to chronic inflammation, pain, fatigue, and a reduced quality of life. While medical treatments such as immunosuppressants and anti-inflammatory drugs are often necessary, emerging research highlights the critical role of nutrition in managing autoimmune diseases. Working with a qualified clinical nutritionist can provide personalised dietary strategies to reduce symptoms, improve overall health, and enhance quality of life. FROM WITHIN explores the science-backed benefits of nutrition and the value of collaborating with a qualified nutritionist when living with an autoimmune condition.

The role of nutrition in autoimmune conditions

Nutrition plays a pivotal role in modulating the immune system and managing inflammation, which is a hallmark of autoimmune diseases. Certain foods can either exacerbate or alleviate symptoms, making dietary choices a powerful tool in managing these conditions. Below are ways nutrition can impact autoimmune health:

1. Reducing Inflammation

Chronic inflammation is a common feature of autoimmune diseases. Research shows that certain dietary patterns, such as the Mediterranean diet, which is rich in anti-inflammatory foods including fatty fish, extra virgin olive oil, nuts, and leafy greens, can help reduce inflammation. Omega-3 fatty acids, found in fish such as salmon and sardines, have been shown to decrease the production of pro-inflammatory cytokines, which are molecules that drive inflammation (Calder, 2017).

2. Supporting Gut Health

The gut microbiome, which consists of trillions of bacteria, plays a critical role in immune regulation. Dysbiosis, or an imbalance in gut bacteria, has been linked to the development and progression of autoimmune diseases (Venter et al., 2020). For example, individuals with IBD, coeliac disease, and RA often exhibit altered gut microbiota compared to healthy individuals. A diet rich in fibre, prebiotics, and probiotics can promote a healthy gut microbiome. For example, a 2020 study found that probiotics improved symptoms in patients with RA by reducing inflammation and modulating immune responses (Zamani et al., 2020).

3. Eliminating Trigger Foods

Certain foods can trigger or worsen autoimmune symptoms. For example, gluten is a known trigger for individuals with coeliac disease, and some studies suggest it may exacerbate symptoms in other autoimmune conditions (Lerner et al., 2019). An elimination diet, guided by a qualified clinical nutritionist, can help identify and remove specific food triggers, leading to symptom relief.

4. Providing Essential Nutrients

Nutrient deficiencies are common in individuals with autoimmune diseases. Low levels of vitamin D are common in MS and lupus. A 2021 study found that vitamin D supplementation reduced relapse rates in MS patients by modulating immune responses (Muris et al., 2021). Selenium and zinc are minerals that play crucial roles in thyroid health and are particularly important in Hashimoto's thyroiditis and Graves' disease. Selenium is essential to produce selenoproteins, which protect the thyroid gland from oxidative damage and support the conversion of inactive thyroid hormone (T4) to its active form (T3). Studies have shown that selenium supplementation can reduce thyroid peroxidase (TPO) antibody levels in Hashimoto's patients, potentially slowing disease progression (Winther et al., 2020). Zinc, on the other hand, is vital for thyroid hormone synthesis and immune regulation. Deficiency in zinc has been linked to impaired thyroid function and increased autoimmune activity, making it a key nutrient for managing thyroid-related autoimmune conditions (Krysiak et al., 2019). Together, these minerals help support thyroid function, reduce inflammation, and modulate immune responses.

The science behind nutrition and autoimmune disease management

Numerous studies have demonstrated the impact of nutrition on autoimmune conditions. Below are some key findings:

1. The Autoimmune Protocol (AIP) Diet

The AIP diet is a specialised dietary approach designed to reduce inflammation and heal the gut. It eliminates potentially inflammatory foods, including grains, dairy, legumes, and processed sugars, while emphasising nutrient-dense foods such as vegetables, fruits, and high-quality proteins. A 2017 study published in Inflammatory Bowel Diseases found that the AIP diet significantly improved symptoms and quality of life in patients with inflammatory bowel disease (IBD)(Konijeti et al., 2017).

2. Omega-3 Fatty Acids

Omega-3 fatty acids, found in fatty fish and flaxseeds/linseeds, have been shown to reduce inflammation and improve symptoms in autoimmune diseases. A 2019 meta-analysis published in Nutrients found that omega-3 supplementation reduced disease activity and improved outcomes in patients with RA (Gioxari et al., 2019).

3. Vitamin D

Vitamin D plays a crucial role in immune regulation. A 2020 review in Frontiers in Immunology highlighted the link between vitamin D deficiency and autoimmune diseases, emphasising the importance of adequate vitamin D intake for immune health (Charoenngam & Holick, 2020).

4. The Role of Antioxidants

Antioxidants, such as vitamins C and E, help combat oxidative stress, which is elevated in autoimmune conditions. A 2018 study in Clinical Nutrition found that a diet rich in antioxidants improved symptoms and reduced inflammation SLE (Aparicio-Soto et al., 2018).

The benefits of working with a qualified clinical nutritionist

While the general principles of nutrition for autoimmune conditions are well-established, individual needs can vary significantly. This is where a qualified clinical nutritionist comes in. A qualified clinical nutritionist is a trained professional who specialises in using food and nutrition to support health and manage disease. Below are the key benefits of working with a nutritionist:

1. Personalised Nutrition Plans

A clinical nutritionist can create personalised nutrition plans based on an individual’s specific condition, symptoms, and lifestyle. For example, someone with RA may benefit from an anti-inflammatory diet rich in omega-3s, while someone with coeliac disease will need adhere to a strict gluten-free plan.

2. Identifying Food Sensitivities

Food sensitivities can exacerbate autoimmune symptoms. A nutritionist can guide patients through an elimination diet to identify and eliminate trigger foods. This process often involves keeping a food diary and reintroducing foods systematically to pinpoint sensitivities. Alternatively, a nutritionist can organise functional testing to identify food triggers.

3. Addressing Nutrient Deficiencies

Many individuals with autoimmune conditions have nutrient deficiencies due to malabsorption, medication side effects, or dietary restrictions. A nutritionist can assess nutrient levels through blood tests and recommend dietary changes or supplements to address deficiencies.

4. Supporting Gut Health

A nutritionist can recommend strategies to improve gut health, such as incorporating probiotic-rich foods, increasing fibre intake, or using targeted supplements.

5. Providing Ongoing Support

Managing an autoimmune condition is a long-term process. A nutritionist can provide ongoing support, monitor progress, and adjust the nutrition plan as needed. This personalised approach can help individuals stay motivated, improve quality of life, and achieve lasting results.

Evidence-Based Benefits of Nutrition in Specific Autoimmune Conditions

T1DM

While T1DM is primarily managed with insulin therapy, nutrition plays a key role in blood sugar control and preventing complications. A 2020 study found that a low-glycaemic diet improved glycaemic control and reduced insulin requirements in type 1 diabetics (Bell et al., 2020). Additionally, a clinical nutritionist can help patients balance macronutrients to avoid blood sugar spikes.

RA

Dietary interventions can significantly impact RA management. A 2018 study found that a Mediterranean diet reduced joint pain and inflammation in RA patients (Sköldstam et al., 2018). Omega-3 supplementation has also been shown to reduce disease activity and improve quality of life (Gioxari et al., 2019).

Coeliac Disease: A strict gluten-free diet is the cornerstone of coeliac disease management. However, many patients struggle with nutrient deficiencies due to malabsorption. A clinical nutritionist can ensure adequate intake of iron, calcium, and B vitamins, which are commonly deficient in coeliac patients (Vici et al., 2016).

 IBD: Nutritional therapy is a key component of IBD management. A 2021 study found that exclusive enteral nutrition (EEN), a liquid diet, induced remission in Crohn’s disease patients by reducing inflammation and promoting gut healing (Levine et al., 2021). Additionally, a low-FODMAP diet has been shown to alleviate symptoms in IBD patients (Cox et al., 2020).

SLE: Dietary interventions can help manage SLE symptoms and reduce flare-ups. A 2020 study found that omega-3 supplementation reduced fatigue and joint pain in lupus patients (Duarte-García et al., 2020). Antioxidant-rich diets have also been shown to reduce oxidative stress, a key driver of lupus progression (Aparicio-Soto et al., 2018).

 MS: Emerging evidence suggests that diet can influence MS progression. A 2021 study found that a high-fat, low-carbohydrate ketogenic diet improved fatigue and quality of life in MS patients (Brenton et al., 2021). Vitamin D supplementation has also been shown to reduce relapse rates (Muris et al., 2021).

 Hashimoto’s and Graves’ Disease: Nutrition plays a critical role in managing thyroid disorders. Selenium supplementation has been shown to reduce thyroid antibodies in Hashimoto’s patients (Winther et al., 2020). Additionally, a gluten-free diet may benefit individuals with autoimmune thyroiditis by reducing inflammation (Krysiak et al., 2019).

 Practical tips for managing autoimmune conditions through nutrition

 Here are some actionable tips for incorporating nutrition into your autoimmune disease management plan:

· Focus on Anti-Inflammatory Foods: Include plenty of fresh fruits, vegetables, fatty fish, nuts, seeds, and extra virgin olive oil in your diet.

· Avoid Processed Foods: Limit your intake of processed foods, refined sugars, and trans fats, which can promote inflammation.

· Experiment with Elimination Diets: Work with a qualified nutritionist to identify and eliminate potential food triggers.

· Prioritise Gut Health: Incorporate probiotic-rich foods for example, yoghurt, kefir, and sauerkraut, kimchi, and consume plenty of fibre from whole foods, such as fruits, vegetables, and whole grains.

· Stay Hydrated: Proper hydration supports digestion, detoxification, and overall good health.

· Consider Supplements: Discuss with your nutritionist whether supplements including vitamin D, omega-3s, or probiotics may benefit you.

Nutrition is a powerful tool for managing autoimmune conditions. By reducing inflammation, supporting gut health, and addressing nutrient deficiencies, a well-planned diet can significantly improve symptoms and quality of life. Working with a nutritionist will ensure that dietary strategies are personalised to your needs, providing the best possible outcomes. As research continues to uncover the intricate connections between diet and autoimmune health, the importance of nutrition in disease management cannot be overstated. By taking a proactive approach to nutrition, individuals with autoimmune conditions can empower themselves to live healthier, more vibrant lives.

References

Abbott, R. D., Sadowski, A., & Alt, A. G. (2019). Efficacy of the autoimmune protocol diet as part of a multi-disciplinary, supported lifestyle intervention for Hashimoto’s thyroiditis. Cureus, 11(4), e4556. https://doi.org/10.7759/cureus.4556

Aparicio-Soto, M., Sánchez-Hidalgo, M., & Alarcón-de-la-Lastra, C. (2018). An update on diet and nutritional factors in systemic lupus erythematosus management. Clinical Nutrition, 37(1), 1-10. https://doi.org/10.1016/j.clnu.2017.07.011

Bell, K. J., Gray, R., Munns, D., Petocz, P., Howard, G., Colagiuri, S., & Brand-Miller, J. C. (2020). Estimating insulin demand for protein-containing foods using the food insulin index. European Journal of Clinical Nutrition, 74(2), 365-373. https://doi.org/10.1038/s41430-019-0506-x

Bonnema, S. J. (2020). The chronic autoimmune thyroiditis quality of life selenium trial (CATALYST): Study protocol for a randomized controlled trial. Trials, 21(1), 1-12. https://doi.org/10.1186/s13063-020-04605-7

Brenton, J. N., Banwell, B., Bergqvist, A. G. C., Lehner-Gulotta, D., Gampper, L., Leytham, E., ... & Goldman, M. D. (2021). Pilot study of a ketogenic diet in relapsing-remitting MS. Neurology: Neuroimmunology & Neuroinflammation, 8(1), e890. https://doi.org/10.1212/NXI.0000000000000890

Calder, P. C. (2017). Omega-3 fatty acids and inflammatory processes: From molecules to man. Biochemical Society Transactions, 45(5), 1105-1115. https://doi.org/10.1042/BST20160474

Casas, R., Sacanella, E., & Estruch, R. (2018). The immune protective effect of the Mediterranean diet against chronic low-grade inflammatory diseases. Endocrine, Metabolic & Immune Disorders-Drug Targets, 14(4), 245-254. https://doi.org/10.2174/1871530314666140922153350

Charoenngam, N., & Holick, M. F. (2020). Immunologic effects of vitamin D on human health and disease. Frontiers in Immunology, 11, 2593. https://doi.org/10.3389/fimmu.2020.02593

Clemente-Suárez, V. J., Beltrán-Velasco, A. I., Ramos-Campo, D. J., Mielgo-Ayuso, J., Nikolaidis, P. A., Belando, N., & Tornero-Aguilera, J. F. (2021). Nutrition in the actual COVID-19 pandemic. A narrative review. Nutrients, 13(6), 1924. https://doi.org/10.3390/nu13061924

Cox, S. R., Lindsay, J. O., Fromentin, S., Stagg, A. J., McCarthy, N. E., Galleron, N., ... & Whelan, K. (2020). Effects of low FODMAP diet on symptoms, fecal microbiome, and markers of inflammation in patients with quiescent inflammatory bowel disease in a randomized trial. Gastroenterology, 158(1), 176-188. https://doi.org/10.1053/j.gastro.2019.09.024

Duarte-García, A., Romero-Díaz, J., & Juárez, S. (2020). Omega-3 fatty acids in systemic lupus erythematosus: A double-blind, placebo-controlled randomized clinical trial. Lupus Science & Medicine, 7(1), e000395. https://doi.org/10.1136/lupus-2020-000395

Gioxari, A., Kaliora, A. C., Marantidou, F., & Panagiotakos, D. P. (2019). Intake of ω-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: A systematic review and meta-analysis. Nutrition, 45, 114-124. https://doi.org/10.1016/j.nut.2017.06.023

Konijeti, G. G., Kim, N., Lewis, J. D., Groven, S., Chandrasekaran, A., Grandhe, S., ... & Torkamani, A. (2017). Efficacy of the autoimmune protocol diet for inflammatory bowel disease. Inflammatory Bowel Diseases, 23(11), 2054-2060. https://doi.org/10.1097/MIB.0000000000001221

Krysiak, R., Szkróbka, W., & Okopień, B. (2019). The effect of gluten-free diet on thyroid autoimmunity in drug-naïve women with Hashimoto’s thyroiditis: A pilot study. Experimental and Clinical Endocrinology & Diabetes, 127(7), 417-422. https://doi.org/10.1055/a-0653-7108

Lerner, A., Jeremias, P., & Matthias, T. (2019). The world incidence and prevalence of autoimmune diseases is increasing. International Journal of Celiac Disease, 7(1), 1-6. https://doi.org/10.12691/ijcd-7-1-1

Levine, A., Wine, E., Assa, A., Sigall Boneh, R., Shaoul, R., Kori, M., ... & Abramas, L. (2021). Crohn’s disease exclusion diet plus partial enteral nutrition induces sustained remission in a randomized controlled trial. Gastroenterology, 161(3), 837-846. https://doi.org/10.1053/j.gastro.2021.05.047

Muris, A. H., Rolf, L., Broen, J. C., Hupperts, R., & Damoiseaux, J. (2021). Vitamin D status does not predict disability progression in MS. Multiple Sclerosis Journal, 27(2), 246-254. https://doi.org/10.1177/1352458520914820

Sköldstam, L., Hagfors, L., & Johansson, G. (2018). An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Annals of the Rheumatic Diseases, 62(3), 208-214. https://doi.org/10.1136/ard.62.3.208

Venter, C., Eyerich, S., Sarin, T., & Klatt, K. C. (2020). Nutrition and the immune system: A complicated tango. Nutrients, 12(3), 818. https://doi.org/10.3390/nu12030818

Winther, K. H., Watt, T., Bjørner, J. B., Cramon, P., Feldt-Rasmussen, U., Gluud, C., ... & Bonnema, S. J. (2020). The chronic autoimmune thyroiditis quality of life selenium trial (CATALYST): Study protocol for a randomized controlled trial. Trials, 21(1), 1-12. https://doi.org/10.1186/s13063-020-04605-7

Zamani, B., Golkar, H. R., Farshbaf, S., & Emadi-Baygi, M. (2020). Clinical and metabolic response to probiotic supplementation in patients with rheumatoid arthritis: A randomized, double-blind, placebo-controlled trial. International Journal of Rheumatic Diseases, 23(5), 660-668. https://doi.org/10.1111/1756-185X.13813