Using Diet to Manage Immune and Autoimmune Diseases Sarah
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 • • • • • • • • Cortisol Insulin Leptin Ghrelin Estrogen Progesterone Melatonin Thyroid hormones HORMONES • • • • • • • • 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 • • • • 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: • • • • • 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 • • • • • • • • • • • • • • 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 • • • • • • • • • • • • • • • 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 • • • • • • • • • • • • • • • • • 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 • • • • • 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
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