THE
PALEO APPROACH
Using Diet to Manage Immune
and Autoimmune Diseases
Sarah Ballantyne, PhD
(aka The Paleo Mom)
HOW DO WE EVALUATE THE MERITS OF INDIVIDUAL
FOODS IN DETERMINING THEIR ROLE IN OUR DIETS?
A HISTORY OF NUTRITIONAL SCIENCES
• 1785, nutritional sciences began as a branch
of chemistry, focused on identification of
chemical constituents of plants and animals
• Research was heavily macronutrient-focused,
as well as understanding digestion and how
muscles use energy, from mid 1700s to early
1900s
• Studies started in mid-18th century to
identify nutritional links to scurvy, night
blindness, goiters, anemia, beriberi, rickets…
• Micronutrients largely identified 1912-1985
THE FIRST DIETARY RECOMMENDATIONS
1916
1944
A HISTORY OF NUTRITIONAL SCIENCES
• 1910s-1970s, nutritional sciences focus on
preventing malnutrition
• First attempts and dietary recommendations
by USDA are micronutrient-focused and
energy-focused
• 1970s-present: links between nutrition and
diseases not directly caused by malnutrition
• Heart disease vs. Nutrition (Pridikin, Keys,
Yudkin)
• Dietary recommendations become more
macronutrient-focus
THE NEXT GENERATION OF DIET GUIDELINES
1977
MACRONUTRIENT-FOCUS
1992
HOW HAVE DIETARY GUIDELINES WORKED?
RISE OF CARDIOVASCULAR DISEASE
Roger V L et al. Circulation 2011;123:e18-e209
Copyright © American Heart Association
RISE OF CARDIOVASCULAR DISEASE
Roger V L et al. Circulation 2011;123:e18-e209
Copyright © American Heart Association
RISE OF CARDIOVASCULAR DISEASE
* Hospital discharges for
cardiovascular disease
(United States: 1970–2007).
Hospital discharges include
people discharged alive,
dead, and “status unknown.”
Roger V L et al. Circulation 2011;123:e18-e209
Copyright © American Heart Association
RISE OF DIABETES
Centers for Disease Control and Prevention www.CDC.gov
RISE OF OBESITY
Centers for Disease Control and Prevention www.CDC.gov
RISE OF CANCER
The United States Program on Cancer, 1975–2006: A Failure (Part 1)
by Anthony D. Apostolides, PhD, and Ipatia K. Apostolides, BA
AUTOIMMUNE DISEASE ON THE RISE
Bach JF. The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J
Med. 2002 Sep 19;347(12):911-20.
WHERE DO WE GO FROM HERE?
UNDERSTANDING NUTRITION
• The intersection between nutrition and
health/disease is complex
• Micronutrients are key (more important than
macronutrients)
• Compounds in foods can undermine health
(antinutrients)
• Evaluating the merits of an individual food
requires detailed understanding
• Nutrigenomics & nutriproteomics
• Nutritional science is still in its infancy
NUTRITION AND INFLAMMATION
• Inflammation is part of the pathogenesis of
all chronic disease
• Understanding the link between nutrition
and the immune system is critical for health.
WE NEED A MORE COMPREHENSIVE CRITERIA
FOR FOOD.
WE NEED MORE DETAILED UNDERSTANDING OF HOW
COMPOUNDS IN FOOD AFFECT HEALTH.
IDENTIFYING A THERAPEUTIC DIET
Autoimmune
Disease
AUTOIMMUNE DISEASE ON THE RISE
Bach JF. The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J
Med. 2002 Sep 19;347(12):911-20.
WHY FOCUS ON AUTOIMMUNE DISEASE
• Our nation’s biggest health obstacle
• Fewest available medical interventions
• High direct health care costs, and even
higher indirect health care costs
WHAT IS AUTOIMMUNE DISEASE?
•
•
•
•
•
Any of >140 diseases
Affects ~50 million Americans
Difficult to diagnose
Chronic and lifelong
Incidence in increasing
Rob Foster robfosterstudio.weebly.com
WHAT IS IMMUNE DISEASE?
• All other chronic illnesses
WHAT CAUSES AUTO/IMMUNE DISEASE?
• Genetic susceptibility
• Infection, environmental triggers, or bad luck
• Diet and lifestyle
Immune Dysregulation
(the body attacks itself)
HOW DO WE EVALUATE THE MERITS OF FOODS IN THE
CONTEXT OF IMMUNE REGULATION?
REGULATING THE IMMUNE SYSTEM
Nutrient
Density
Immune
System
Regulation
Gut
Health
Hormone
Regulation
WHERE DOES FOOD FIT IN?
REGULATING THE IMMUNE SYSTEM
Nutrient
Density
Immune
System
Regulation
Gut
Health
Hormone
Regulation
NUTRIENT DENSITY
• Many micronutrients are used by the
immune system
• Many micronutrients are immune regulators
•
•
•
•
•
•
Vitamin A
Vitamin D
Vitamin E
Vitamin K (K2)
Vitamin B6 (pyridoxine)
Vitamin B9 (folate)
•
•
•
•
•
Vitamin B12 (cobalamin)
Zinc
Selenium
Iron
Copper
• When you are deficient in these
micronutrients, the immunes system can’t
regulate itself…
DEFICIENCY IS COMMON!
Percentages of all individuals (≥2yrs) not meeting RDA
Nutrient
% not meeting RDA
Vitamin B12
17.2
Niacin (B3)
25.9
Phosphorus
27.4
Riboflavin (B2)
30.0
Thiamine (B1)
30.2
Folate (B9)
33.2
Vitamin C
37.5
Iron
39.1
Vitamin B6
53.6
Vitamin A
56.2
Magnesium
61.6
Calcium
65.1
Zinc
73.3
Cordain L et al. Am J Clin Nutr February 1, 2005 vol. 81 no. 2 341-354
ZINC AND THE IMMUNE SYSTEM
• Diverse Functions:
–
–
–
–
–
–
–
–
Activity of approximately three hundred different enzymes
DNA and RNA transcription
Regulates apoptosis
Absorption and activity of B vitamins
Muscle contraction
Connective tissue formation
Production of insulin and testosterone
Component of vitamin D receptor
• Adaptive Immune System
– Control of T cell differentiation and activation.
– Reduces cytokine production by Th1 and Th17 cells.
• Deficiency associated with: rheumatoid arthritis, multiple
sclerosis, pemphigus vulgaris, Alzeimer’s disease, autoimmune
hepatitis, primary biliary cirrhosis, autoimmune thyroid
disease, systemic lupus erythematosus, celiac disease and type
1 diabetes.
VITAMIN A AND THE IMMUNE SYSTEM
• Diverse functions:
–
–
–
–
Bone health
Ocular health
Immune health
Maintenance and normal regeneration of mucosal
barriers
• Innate Immune System
– Required by inflammatory cells to function (neutrophils,
macrophages, and natural killer cells)
• Adaptive Immune System
– Deficiency decreases Th2 cells and increases Th17 cells
– Required for Treg cell formation in the thymus
• Deficiency associated with: alopecia areata, multiple
sclerosis, and autoimmune hepatitis
WHERE DO DEFICIENCIES COME FROM?
Gross L S et al. Am J Clin Nutr 2004;79:774-779
WHERE DO DEFICIENCIES COME FROM?
Data from the USDA Economic Research Service, Food Availability (Per Capita) Data System www.ers.usda.gov
WHERE DO DEFICIENCIES COME FROM?
• Vegetables and fruits have less vitamins than
they used to…
Vitamin A
Thiamin (B1)
Riboflavin (B2)
Niacin (B3)
Vitamin C
Garden Crops
(% now compared to 1950s)
82%
101%
62%
99%
85%
Davis DR et al. Changes in USDA Food Composition Data for 43 Garden Crops, 1950 to 1999 J
Am Coll Nutr December 2004 vol. 23 no. 6 669-682
WHERE DO DEFICIENCIES COME FROM?
• Vegetables and fruit have less minerals than
they used to….
Vegetables
(% now compared to 1950s)
Fruit
(% now compared to 1950s)
Calcium
81%
100%
Magnesium
65%
89%
Iron
78%
68%
Copper
19%
64%
Sodium
57%
90%
Potassium
86%
80%
Phosphorous
94%
99%
Anne-Marie Mayer, (1997) "Historical changes in the mineral content of fruits and
vegetables", British Food Journal, Vol. 99 Iss: 6, pp.207 - 211
WHERE DO DEFICIENCIES COME FROM?
CALORIE RICH AND NUTRIENT POOR
• Grain-based diets are inherently
nutrient-poor
• Grains are not nutritional
powerhouses.
• You get more (better) fiber
from vegetables!
• Grains are fortified because
of malnutrition!
• Grains have very little
redeeming nutritional value
• Grains are pure
carbohydrate = sugar!
WHY NO GRAINS?
• Vegetables have WAY more nutrition.
WHY NO GRAINS?
• Meat has WAY more nutrition
The only vitamin or mineral that grains have more of than meat in manganese… and there’s still
more manganese in vegetables.
WHERE DO DEFICIENCIES COME FROM?
REGULATING THE IMMUNE SYSTEM
Nutrient
Density
Immune
System
Regulation
Gut
Health
Hormone
Regulation
HORMONES
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Cortisol
Insulin
Leptin
Ghrelin
Estrogen
Progesterone
Melatonin
Thyroid
hormones
HORMONES
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Cortisol
Insulin
Leptin
Ghrelin
Estrogen
Progesterone
Melatonin
Thyroid
hormones
SUGAR
WHERE DOES EXCESS SUGAR COME FROM?
WHY NO GRAINS?
2 slices of “healthy” whole wheat bread increases
blood sugar more than 6 spoonfuls of sugar!
WHY NO GRAINS?
REGULATING THE IMMUNE SYSTEM
Nutrient
Density
Immune
System
Regulation
Gut
Health
Hormone
Regulation
GUT HEALTH
• A leaky gut has been found in every
autoimmune disease in which it has
been studied.
• A leaky gut and/or
gut dysbiosis may be necessary for all
autoimmune diseases to develop.
GUT MICROBIOME
• Gut bacteria have diverse benefits:
– Aid digestion
– Produce SCFA
– Synthesize Vitamins
– Increase nutrient absorption
– Produce neurotransmitters
– Regulate the immune system
THE GUT BARRIER
THE EPITHELIAL CELL
•
•
•
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Form all barrier
tissues
Form a single sheet
Columnar cells
Selectively permeable
membrane
Tight junction both
connects adjacent
cells and separates
the apical from the
basolateral
membranes
LEAKY GUT
Compounds in
food that open
tight junctions:
• Agglutinins,
• Prolamins (via zonulin)
• Alcohols
Compounds in food that
damage epithelial cells:
• Agglutinins
• Prolamins
• Saponins (glycoalkaloids)
Compounds in food that
feed gut dysbiosis:
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•
Prolamins
Agglutinins
Alcohols
Excess sugars and starch
Digestive enzyme inhibitors
PROLAMINS AND AGGLUTININS
Not all lectins are bad…. BUT:
• Two classes of toxic lectins in grains:
prolamins and agglutinins
• Both are difficult to digest.
• Can feed gut dysbiosis
• Both can damage the cells that form the
gut barrier
• Can cause “leaky gut”
• Both are good at getting across the gut
barrier intact
• Inflammatory
• Both stimulate the immune system.
HOW PROLAMINS DAMAGE THE GUT
• Most of what we know about prolamins
comes from the study of gluten
• Enters the body intact via several pathways
• Paracellular (zonulin)
• Transcellular
• Retrotranscytosis
• Lysosomal
• Stimulates Immune System
• Inhibits digestion
• Feeds gut dysbiosis
• High rate of intolerance/sensitivity
PARACELLULAR PATHWAY
TRANSCELLULAR PATHWAY #1
TRANSCELLULAR PATHWAY #2
PROLAMINS CAUSE GUT DYSBIOSIS
• Interfere with digestive enzymes in the
brush border
• Lactase
• Sucrase
• Dipeptidyl Peptidase 4
• Gluten overfeeds intestinal bacteria
• Gluten preferentially feeds E. Coli
HOW AGGLUTININS DAMAGE THE GUT
• Most of what we know about prolamins
comes from the study of wheat germ
agglutinin, soy lectin, peanut lectin, kidney
bean lectin, concanavalin (jack beans), and
tomato lectin.
• Enters the body intact via several pathways
• Stimulates Immune System--adjuvant
• Inhibits digestion
• Feeds gut dysbiosis
WGA PATHWAYS
AGGLUTININS GET INTO THE BODY
• WGA is so good at crossing the gut
barrier intact it has been investigate as a
drug delivery molecule
• WGA is a very strong stimulator of the
immune system
• Kidney bean lectin is very good at getting
into bloodstream
• Peanut lectin enters bloodstream very
quickly after consumption
• Agglutinins from nettle, soy, jackbeans,
kidney beans, wheat, tomatoes ALL cross
the gut barrier and cause leaky gut.
AGGLUTININS AS DRUGS
• WGA has been investigate as a drug
delivery molecule
• Tomato lectin has been investigated as an
adjuvant for vaccines
• Soy lectin has been investigated as an
adjuvant for vaccines
• Not what is meant by “Let food be thy
medicine…”
MORE BAD STUFF AGGLUTININS DO
• Kidney bean lectin causes extensive
overgrowth of E. coli
• Agglutinins all profoundly stimulate the
immune system
• Increase antigen-presenting cell
activity
• Increase Th1, Th2, Th17 cell activity
and proliferation
• Decrease regulatory T-cells
• Stimulate neutrophils
• Stimulate ROS formation
WHERE DOES THIS COME FROM?
FOODS FOR YOUR GUT BACTERIA
Gross L S et al. Am J Clin Nutr 2004;79:774-779
FIBER, FIBER, FIBER!
• Two biggest corrective influences on gut
microbiome are fiber intake (especially
insoluble from non-starchy vegetables) and
long-chain omega-3 fats (from seafood)
THERAPEUTIC VALUE OF FOOD
Cut out foods that:
Focus on foods that:
• Are nutrient-poor
• Are inflammatory
• Damage the gut
• Feed gut
dysbiosis
• Dysregulate
hormones
• Are nutrient-rich
• Are antiinflammatory
• Support healing
• Promote a healthy
gut microbiome
• Regulate hormones
CHOOSING FOODS
Bad
Stuff
Good
Stuff
THE PALEO APPROACH
A THERAPEUTIC DIET FOR AUTOIMMUNE
AND OTHER CHRONIC DISEASE
WHAT DOES THIS LOOK LIKE?
Paleo
+
No Grains
No Legumes
No Dairy
No Refined Oils
No Refined Sugars
No Processed Foods
Autoimmune
No Nuts
No Seeds
No Eggs
No Nightshades
No Alcohol
No Coffee
No Chocolate
No Dairy
WHAT DOES THIS LOOK LIKE?
Paleo
Meat
Poultry
Seafood
Vegetables
Mushrooms
Fruit
Quality Fats
+
Autoimmune
Seafood
Organ Meat
Vegetables
FOCUS ON NUTRIENT-DENSITY
• Tolerance for “cheats” improves with overall
nutrient-density of diets
• The more nutrient-dense your diet, the
faster health conditions can resolve
• This means focus on
• Offal
• Seafood
• Vegetables (lots!!!)
As the foundation of your diet.
SEAFOOD
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• Chromium
•
• Calcium
•
• Trace Minerals •
Omega-3 fatty acids
Vitamin A
Vitamin D
Vitamin E
Vitamin K
Vitamin B12
Calcium
Phosphorus
Selenium
Iodide
Iron
Zinc
Magnesium
Potassium
Glycine
Tryptophan
SEAFOOD
FISH:
3 Times Per Week
MINIMUM
SHELLFISH:
1-2 Times Per Week
MINIMUM
SEA VEGETABLES:
1 Time Per Week
MINIMUM
OFFAL
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Glycine
•
Tryptophan
•
Omega-3 fatty acids •
Conjugated Linoleic •
Acid
•
Vitamin A
Vitamin D
Vitamin E
Vitamin K
Vitamin B12
Folate
Copper
Potassium
Magnesium
Calcium
Phosphorus
Manganese
Iron
Selenium
Zinc
Coenzyme Q10
EAT SNOUT TO TAIL
22% of the edible portion of cattle is offal
24% of the edible portion of hog is offal
3-5 Times Per Week
MINIMUM
VEGETABLES
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Chlorophyl
•
Antioxidants
Glycine Betaine •
•
FIBER
Vitamin C
Vitamin E
Vitamin K
Vitamin B3
Folate
Iron
Calcium
Potassium
Magnesium
Phosphorus
Manganese
Sulfur
Selenium
Copper
Carotenoids
Polyphenols
VARIETY, VARIETY, VARIETY
AND THE MORE THE BETTER!
8-10 Servings Per Day
MINIMUM
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Leafy Greens
Colorful Veggies
Cruciferous Veggies
Roots and Tubers
Vegetable-Like Fruits
A THERAPEUTIC DIET
FOCUS ON NUTRIENT-DENSITY FIRST
THANK YOU!
www.ThePaleoMom.com