Healthy Eating for Those with Autoimmune Disorders

It can be difficult to discern which foods to include or restrict in a diet when living with an autoimmune disorder, but it comes down to assessing what is best for each individual.

It seems like every day a spotlight shines on another food we should contemplate adding to or excluding from our diets. Sometimes, it can seem nearly impossible to keep up with what foods are the best or worse, particularly for those with autoimmune disorders. And, the answer is: Like many aspects of nutrition, health and wellness, it depends. While diet alone may not provide the solution to every aspect of an autoimmune disorder, it definitely plays a major role in managing symptoms, supporting immunity and providing an overall sense of well-being. There are foods that can pose a challenge for certain autoimmune disorders, as well as some foods that may be beneficial to include in the diet.

Foods to Avoid

Nightshades. Nightshades are a group of vegetables that are a part of the Solanaceae family. While many plants that are part of the nightshade family are inedible, some of the most common edible forms include tomatoes, peppers, eggplant and white potatoes (sweet potatoes and yams are not included in the nightshade family). These vegetables are natural sources of nitrogen-containing alkaloids, specifically solanine. Some individuals, especially those with an autoimmune disorder, can have an increased sensitivity to solanine, which can potentially increase the amount of inflammation in the body. While more research is needed to tie nightshades to inflammation, there are a limited number of preliminary studies that explore the possibility that nightshades can exacerbate inflammatory bowel disease (IBD)¹ and/or leaky gut symptoms.²

The key takeaway when it comes to nightshade vegetables is they do contain a number of beneficial nutrients such as fiber, vitamins and minerals, just like any other fruit or veggie. They should only truly be avoided if they aren’t tolerated well or if they make autoimmune symptoms worse. This comes down to individual experience, and it can be a sign to explore things further if you notice an increase in unwanted symptoms when nightshades are included in the diet.

Added sugars. It’s no surprise that too much added sugar in the diet is not exactly beneficial for our health. Aside from providing minimal nutrition, a high amount of added sugars in the diet may also impact autoimmune disorders. Recent research has suggested a connection between high sugar intake and worsened symptoms with certain autoimmune disorders such as Crohn’s disease and multiple sclerosis (MS).³

The 2015-2020 Dietary Guidelines for Americans recommends limiting added sugars in the diet to 12 teaspoons a day, or about 200 calories

The 2015-2020 Dietary Guidelines for Americans recommends limiting added sugars in the diet to 12 teaspoons a day, or about 200 calories.⁴ Some easy ways to minimize added sugars include:

• Swapping out sugary beverages such as soda, lemonade or sweetened teas for water. Instead, opt for a flavored unsweetened seltzer water if you want something with flavor and fizz.
• Sweetening foods Use fruit or a minimal amount of sweetener in foods like cereal, oatmeal or yogurt to add sweetness instead of buying those that are already sweetened.
• Limiting portion sizes. Reducing added sugars doesn’t mean you have to give up your favorite treats entirely. Opt for a smaller portion, and truly enjoy every bite. Giving all your attention to savoring your favorite treat can bring you enjoyment with a smaller amount.

Gluten. Adhering to a gluten-free diet is a well-known and standard protocol for those with celiac disease. This means eliminating any foods containing gluten, which includes anything made from wheat, rye or barley. The prevalence of gluten-free alternatives to common foods like breads, pastas, cereals and crackers makes it easier for those with celiac disease to eliminate gluten from the diet, without eliminating favorite foods in the process.

The later in life someone is diagnosed with celiac disease comes with an increased risk of developing another autoimmune disorder. Some of the most common autoimmune disorders associated with celiac disease include thyroid disease and type 1 diabetes. While a gluten-free diet is most commonly applied to those with celiac disease, some research has shown that following a gluten-free diet can be beneficial for those with a thyroid disease as well.^5,6 Eliminating gluten from the diet may be easier to navigate with the abundance of alternatives widely available, but it still takes careful shopping, planning and awareness to follow.

High-sodium foods. Much like added sugars, including too much sodium in the diet can be harmful to overall health, but it can also significantly impact autoimmune disorders. A 2018 study found a high sodium intake was associated with an increased risk of rheumatoid arthritis,⁷ and emerging research has suggested a possible connection between a higher salt intake and an increase in symptoms for MS, IBD and lupus.⁸

Some high-sodium foods include:

• Cured meats (salami, pepperoni, ham, )
• Canned soups or broths
• Frozen meals
• Fast food or take-out meals
• Condiments (salad dressing, soy sauce, barbecue sauce, etc.)

One of the easiest ways to cut back on sodium intake is to cut out the salt shaker. Limit how much or how often you sprinkle your foods with salt at the dinner table, and instead use sodium-free seasonings like fresh herbs and spices to add flavor to your meals. Opting for low-sodium canned beans, vegetables and broths, and enjoying home-prepared meals more often than dining out can also be easy ways to cut back on how much salt you have each day.

Foods to Include

It can be all too easy to get caught up and overwhelmed with the foods that should be avoided or limited with autoimmune disorders. Often, it can be more productive to focus on foods to include in your diet on a regular basis. Here are some of the recommended beneficial foods for autoimmune disorders.

Fruits and vegetables. This shouldn’t come as a surprise, but including an abundance of fruits and vegetables in the diet is beneficial for overall health and for supporting autoimmune disorders. Foods like berries, broccoli, avocados and leafy greens (spinach, kale, Swiss chard) are rich in immune-supporting nutrients such as the antioxidants vitamin C and vitamin A, magnesium and potassium, all of which are important when it comes to autoimmune disorder management. Aim to get a variety of fruits and vegetables that you tolerate well in your diet on a daily basis. Preparing vegetables in new ways like roasting or sautéing or using different seasonings can be easy ways to keep them from getting redundant.

Omega-3 fats. Another important part of an autoimmune diet is the inclusion of healthy fats, particularly omega-3 fatty acids. These healthy fats can be found in many forms and in a variety of foods such as:

• Salmon and other fatty fish
• Nuts and seeds (walnuts, chia seeds, flax)
• Plant-based oils (flax oil, canola oil)
• Fortified foods (eggs, yogurt, juice, milk)
• Supplements and fish oils

Research has shown the inclusion of omega-3 fatty acids either in food or supplement form can help reverse the progression of a number of inflammatory diseases such as lupus, MS and IBD.⁹

Vitamin D. Another nutrient of focus for autoimmune disorders is vitamin D. Research has shown vitamin D plays an important role in immunity, and a vitamin D deficiency has been linked to multiple autoimmune disorders such as rheumatoid arthritis, diabetes, IBD and MS.¹⁰ Low levels of vitamin D are not uncommon; approximately one billion people worldwide have a vitamin D deficiency, and about 50 percent of the population has insufficient levels of vitamin D.¹¹

If you’re looking to increase your vitamin D levels, some of the best foods or sources are:

• Wild-caught salmon
• Sardines
• Herring
• Egg yolks
• Fortified foods (milk, soy milk, cereals, juices)
• Supplements

Dairy. One food group that often gets a bad reputation when it comes to autoimmune disorders is dairy. This includes foods such as yogurt, cheese and anything containing or made from milk. Many times, difficulties digesting dairy products, lactose intolerance or malabsorption are thought to come with IBD-related disorders such as Crohn’s or ulcerative colitis. Research has shown including dairy in the diet can actually be beneficial for protecting against these autoimmune disorders, unless they are causing trouble for the individual.¹²

If dairy foods do seem to cause trouble or are difficult to digest, it may be beneficial to speak with a medical provider about assessing if these foods need to be limited or avoided in the diet or at least to get to the root cause of the issue. Some adverse symptoms to be aware of when it comes to dairy products includes:

• Gas or bloating
• Stomach cramping
• Diarrhea or nausea

If dairy products don’t cause any unwanted or adverse symptoms, including them in the diet can be beneficial for autoimmune disorders, while also providing the diet with calcium, vitamin D and protein.

Assess What Is Best for You

It can be overwhelming to determine what to eat or avoid consuming, especially when trying to manage an autoimmune disorder. The key is to do what is best for you and your body. If a particular food doesn’t give you trouble, you may not need to exclude it from your diet. On the flipside, if something truly is making symptoms worse, use it as a sign to explore things further with your medical provider to come up with the best management plan specifically for you.

References

1. Iablokov, V, Sydora, BC, Foshaug, R, et al. Naturally Occurring Glycoalkaloids in Potatoes Aggravate Intestinal Inflammation in Two Mouse Models of Inflammatory Bowel Disease. Digestive Diseases and Sciences, 2010 Nov;55(11):3078-85. Accessed at pubmed.ncbi.nlm.nih.gov/20198430.
2. Carreno-Gómez, B, Woodley, JF, and Florence, AT. Studies on the Uptake of Tomato Lectin Nanoparticles in Everted Gut Sacs. International Journal of Pharmacy and Pharmaceutical Sciences, 1999 Jun 10;183(1):7-11. Accessed at pubmed.ncbi.nlm.nih.gov/10361144.
3. National Institutes of Health. High Sugar Intake Worsens Autoimmune Disease in Mice, Aug. 27, 2019. Accessed at www.nih.gov/news-events/nih-research-matters/high-sugar-intake-worsens-autoimmune-disease-mice.
4. 4. Ožice of Disease Prevention and Health Promotion. Cut Down on Added Sugars. In 2015-2020 Dietary Guidelines for Americans. Accessed at health.gov/dietaryguidelines/2015/resources/DGA_Cut-Down-On-Added-Sugars.pdf.
5. Celiac Disease Foundation. Autoimmune Disorders. Accessed at celiac.org/about-celiac-disease/related-conditions/autoimmune-disorders.
6. Krysiak, R, Szkróbka, W, and Okopień, B. The Ežect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto’s Thyroiditis: A Pilot Study. Experimental and Clinical Endocrinology and Diabetes, 2019 Jul;127(7):417-422. Accessed at pubmed.ncbi.nlm.nih.gov/30060266.
7. Sharif, K, Amital, H, and Shoenfel, Y. The Role of Dietary Sodium in Autoimmune Diseases: The Salty Truth. Autoimmune Reviews, 2018 Nov;17(11):1069-1073. Accessed at pubmed.ncbi.nlm.nih.gov/30213699/.
8. Scrivo, R, Perricone, C, Altobelli, A, et al. Dietary Habits Bursting Into the Complex Pathogenesis of Autoimmune Diseases: The Emerging Role of Salt from Experimental and Clinical Studies. Nutrients, March 28, 2019. Accessed at www.mdpi.com/2072-6643/11/5/1013/pdf.
9. Zivkovic, AM, Telis, N, German, JB, and Hammock, BD. Dietary Omega-3 Fatty Acids Aid in the Modulation of Inflammation and Metabolic Health. California Agriculture (Berkeley), 2011 July-September; 65(3): 106–111. Accessed at www.ncbi.nlm.nih.gov/pmc/articles/PMC4030645.
10. Aranow, C. Vitamin D and the Immune System. Journal of Investigational Medicine, 2011 Aug; 59(6): 881–886. Accessed at www.ncbi.nlm.nih.gov/pmc/articles/PMC3166406.
11. Sizar, O, Khare, S, Goyal, A, et al. Vitamin D Deficiency. StatPearls, July 21, 2020. Accessed at www.ncbi.nlm.nih.gov/books/NBK532266.
12. Szilagyi, A, Galiatsatos, P, and Xue, X. Systematic Review and Meta-Analysis of Lactose Digestion, Its Impact on Intolerance and Nutritional Ežects of Dairy Food Restriction in Inflammatory Bowel Diseases. Nutrition Journal, Volume 15, Article number: 67 (2015). Accessed at nutritionj.biomedcentral.com/articles/10.1186/s12937-016-0183-8.