Vitamin D Deficiency
And
Autoimmune Diseases
Sometimes the Immune System itself goes haywire, seemingly becoming paranoid and mounting pre-emptive strikes against normal cells of the body, reacting as if they were dangerous and needed elimination. This is the basis of “autoimmune disorders.” For example, if your Immune System kills off your insulin producing cells (beta cells) in your pancreas, you develop Type 1 diabetes. If the target of the attack is your respiratory system, you develop asthma. If the target is nerve tissue, you develop Multiple Sclerosis (MS). If the target is the thyroid gland, you develop either Hashimoto’s thyroiditis or Graves’ disease. If the target is the intestines, you develop Crohn’s disease or Ulcerative colitis. If the target is joints, you develop Rheumatoid arthritis or Systemic Lupus Erythematosus (SLE). Perhaps now, you can appreciate how important it is to keep your Immune System normal in order to enjoy true health!
Modern research has clearly established that vitamin D plays a vital role in the normal functioning of the Immune System. In response to an invading pathogen such as a virus or a bacterium, vitamin D helps immune cells to produce a number of antimicrobial chemicals, in particular a chemical called cathelicidin antimicrobial peptide (camp ), which works like an antibiotic, but without the side-effects associated with antibiotics.
On the other hand, when immune cells are inappropriately alarmed and become overactive and kill your own tissues, as happens in autoimmune diseases, vitamin D calms these overactive immune cells.
When it comes to cancer, vitamin D works through several mechanisms including your immune cells. I elaborate on this subject in Chapter 11, Vitamin D Deficiency and Cancer.
These are breakthrough discoveries! So far, traditional medicine has ignored the immune system’s natural capacity in the treatment of infections, autoimmune diseases and cancers. For infections, all it can offer is antibiotics, which often have serious side-effects. For cancers, all it can offer is chemotherapy, radiation and surgery; each modality comes with an array of horrendous side-effects and complications. For autoimmune disorders, all it can offer is drugs that blindly suppress the immune system. Each one of these immune-suppressing drugs has a long list of side-effects and complications. Hopefully, modern medicine will embrace the new amazing discoveries about the role of vitamin D as a natural antibiotic, a natural anti-cancer and a natural immune modulator. And this could revolutionize the practice of medicine.
Asthma
There is strong link between vitamin D deficiency and asthma. In the USA, the prevalence of asthma has increased dramatically from about 3 % in the 1970’s to about 8% in recent years. Experts in the field of asthma speculate the epidemic of asthma to be linked to the epidemic of vitamin D deficiency, as both of these epidemics started in the last few decades.
The northeast tops the USA in the prevalence of asthma. In this region during winter, there is inadequate UVB from the sun for the synthesis of vitamin D. Therefore, scientists wondered whether vitamin D deficiency could be responsible for the development of asthma and whether vitamin D supplementation could be helpful in the prevention and treatment of asthma.
In a study (1) from Brigham and Women’s Hospital, Boston, USA, researchers measured vitamin D level in 1024 children with mild-to-moderate persistent asthma and followed these children over a 4-year period for severe attacks of asthma, requiring a visit to the emergency department or admission to the hospital. They found a clear association between low level of vitamin D and severe attacks of asthma.
Not only children, but adults with asthma are also at increased risk for severe attacks if they are low in vitamin D. In a study (2) from the University of New Mexico, Albuquerque, USA, the researchers analyzed vitamin D levels in 92 adults with asthma treated at their hospital over a span of five years. They found the risk of severe asthma attack was reduced by 59% if your level of vitamin D was above 30 ng/ml. This is an amazing finding. If some drug showed this type of result, it would become the standard of treatment. Sadly, physicians continue to ignore the health benefits of vitamin D in treating asthma patients.
An upper respiratory tract infection often triggers an attack of asthma. Children and adults low in vitamin D are at an increased risk for upper respiratory tract infections. Therefore, vitamin D supplement may prevent an attack of asthma by preventing upper respiratory infections. In addition, vitamin D reduces inflammation in the bronchial tree. In this way, it may be helpful in treating the asthma attack as well.
Physicians often use steroids to treat severe asthma, but sometimes patients are resistant to steroids. This is known as steroid-resistant asthma. Vitamin D has been shown to make steroid treatment more effective in these individuals. In a recent study (3) from L.M. College of Pharmacy, India, researchers showed vitamin D improves steroid efficacy and attenuates its side-effects in an animal model of asthma.
Sound medical research has shown that vitamin D plays a significant role in the development of the Immune System and lungs during fetal growth. Studies (4) have shown that vitamin D supplementation during pregnancy can substantially reduce the risk of asthma in a child.
In summary, vitamin D deficiency increases the risk of the development of asthma as well as its exacerbations. A good vitamin D level can prevent an attack of asthma. In addition, a good vitamin D level is helpful in treating the asthma attacks.
Fibromyalgia, Rheumatoid Arthritis, Osteoarthritis, Psoriatic Arthritis, Systemic Lupus Erythematosus (SLE)
Vitamin D deficiency is extremely common in patients with fibromyalgia, rheumatoid arthritis, osteoarthritis, psoriatic arthritis, lupus (SLE) and various other rheumatologic diseases. This is an area of intense research.
A number of studies have shown vitamin D level to be low in patients with fibromyalgia. Can vitamin D supplementation improve fibromyalgia? A well designed study (5) from the Clinical Research Center, Saudi Arabia enrolled 100 women with fibromyalgia. Sixty one women were found to have markedly low vitamin D level (less than 20 ng/ml). These women received vitamin D as 50,000 IU once weekly until their blood level of 25-OH vitamin D exceeded 50 ng/mL. Forty two (69%) of these women showed a marked improvement in their fibromyalgia once their vitamin D level rose above 50 ng/mL.
This finding is in line with my clinical observation at the Jamila Diabetes and Endocrine Medical Center. You need high doses of vitamin D to show an impact on autoimmune disease. I aim for 25-OH vitamin D to be close to 100 ng/ml in my patients with autoimmune disorders. Some studies in literature that do not show an improvement with vitamin D supplementation use miniscule doses of vitamin D.
Several studies link a low level of vitamin D to various types of arthritis. In 2015, a study (6) from Sestre Milosrdnice Clinical Hospital Centre, Zagreb, Croatia found low vitamin D (less than 30 ng/ml) in 94% of patients with rheumatoid arthritis, 97% of patients with osteoarthritis and 74% of patients with psoriatic arthritis.
A study (7) from the University of Iowa, USA, showed that vitamin D intake was inversely associated with risk of rheumatoid arthritis. People with a higher intake of vitamin D were at low risk for the development of rheumatoid arthritis.
Patients with rheumatoid arthritis also suffer from muscle aches and pains (fibromyalgia). Could it be related to low vitamin D? In 2014, a well designed study (8) from Cairo University, Egypt, found that rheumatoid patients with fibromyalgia had lower vitamin D levels compared to those rheumatoid patients who did not have fibromyalgia. Vitamin D level also correlated with the quality of life in rheumatoid patients.
Several studies also indicate low vitamin D plays a role in patients with SLE (Systemic Lupus Erythematosus). In one study (9), researchers from the University of Western Ontario, Canada found that over 50% of their SLE patients were very low in vitamin D. They also made an interesting observation: hydroxychloroquine, a commonly used drug for rheumatologic disorders, interfered with the conversion of vitamin D to its active form. Therefore, if you take hydroxychloroquine, you may require much higher doses of vitamin D supplement to compensate for the inhibitory action of hydroxychloroquine on vitamin D conversion.
In another study (10) researchers from Medical University of South Carolina, Charleston, USA, found 67% of their SLE patients to be very low in vitamin D, and there was a trend for all patients to be low in vitamin D.
Multiple Sclerosis (M.S.)
Multiple sclerosis is a chronic debilitating disease that affects the brain, spinal cord and the nerves. It usually starts in young adulthood and practically robs a person’s quality of life. There are recurring episodes of neurologic dysfunction which can result in partial or complete loss of function of an organ. Usual symptoms are loss of vision, difficulty in speech, lack of balance, tremors, loss of bladder control, vomiting, and sometimes, paralysis of an arm or leg.
While the exact cause of M.S. remains unknown, genetics, geographic location and immune dysfunction play a significant role in causing and perpetuating M.S.; Researchers have known for a long time that M.S. is primarily is a disease of northern Europe, the northern U.S. and Canada. It is rare in Africa and Asia. Even in the USA, its prevalence in the south is 50% less than in the north. In order to find the exact cause of M.S., most researchers have focused on finding an environmental factor, such as a virus. However, all that research has failed miserably.
Some researchers, on the other hand, looked at the obvious: M.S. occurs more frequently in northern areas with less sunshine. They speculated on the role of vitamin D deficiency in causing M.S. This quest finally led to the landmark experimental studies (11, 12) in which vitamin D supplementation completely prevented M.S. in animal models. Vitamin D therapy also prevented the progression of M.S. in these experimental animals. These miraculous findings led researchers to believe that vitamin D is a natural inhibitor of M.S.
In 2015, a tantalizing study (13) came from Thomas Jefferson University, Philadelphia, USA. This study sheds light on the mechanisms how vitamin D may prevent as well as treat M.S. These researchers showed that vitamin D significantly increases proliferation of the “mother brain cells” called Neural Stem Cells and enhances their differentiation into neurons and the myelinating cells in the brain and spinal cord.
Based on these findings, researchers in the field of M.S. now recommend that vitamin D supplementation be an integral part of treatment of individuals with M.S. In addition, those who are genetically at a high risk for developing M.S. should be supplemented with vitamin D.
In these patients, a good level of vitamin D (a level between 50-100 ng/ml or 125-250 nmol/L) should be targeted. How to achieve this level is discussed in Chapter 26: Treatment of Vitamin D Deficiency.
Autoimmune Diabetes Mellitus (Type 1 Diabetes)
Type 1 diabetes mellitus (DM Type 1) usually affects younger individuals, often children. Rarely, it can affect older persons.
DM Type 1 is an autoimmune disease. In simple terms, your immune system starts malfunctioning. It misidentifies your own insulin producing cells in the pancreas as foreign and starts destroying them. It mounts an ongoing attack on your insulin producing cells until it eventually kills them all. Consequently, you can’t produce any more insulin, your blood glucose escalates and you’re diagnosed with diabetes.
Vitamin D Level In Type 1 DM Patients
I test vitamin D level in all of my patients with DM Type 1. I find it to be low in virtually all of them. My experience is in line with other researchers in this field. In a study, (14) researchers from the Joslin Diabetes Center, Boston, USA, noted that the vast majority of their Type 1 diabetic patients were low in vitamin D. The study was done in children and teenagers.
Can Vitamin D Deficiency Cause Type 1 Diabetes Mellitus? Can It Be Prevented With Vitamin D Supplementation?
True researchers (the ones NOT working for drug companies) were intrigued with the possibility that vitamin D deficiency could be causing DM Type 1 by interfering with the normal functioning of the immune system. Indeed, this turns out to be the case. Ground breaking research (15) from Finland showed a clear relationship between vitamin D deficiency and risk for developing Type 1 diabetes. It also showed Type 1 diabetes can be prevented by adequate vitamin D supplementation
This study (15) began in 1966 when a total of 10,821 children born in 1966 in northern Finland were enrolled in the study. Frequency of vitamin D supplementation was recorded during the first year of life. At that time, the recommended dose of vitamin D for infants in Finland was 2000 I.U. per day. These children were then followed for 31 years for the development of Type 1 diabetes. Researchers made the amazing discovery that those children who received the daily recommended dose of 2000 I.U. of Vitamin D during the first year of their life had an almost 80% reduction in the risk for the development of Type 1 diabetes compared to those children who received less vitamin D.
This is an astounding study ! If some drug achieved this kind of results, it would hit the headlines and become the standard of care at once. Sadly, even many diabetes experts are not aware of this great study.
Investigators in the USA continue to spend millions of dollars in their pursuit of a “drug” to prevent Type 1 diabetes. So far, this kind of research has produced disappointing results. Amazingly, they have largely ignored the strong evidence that shows the outstanding role of vitamin D in preventing Type 1 diabetes. Vitamin D is not a drug. There is no glory or huge profits in simply telling people to take enough vitamin D.
It is interesting to note that the recommended allowance of vitamin D for infants in Finland was reduced from 2000 I.U. to 1000 I.U. per day in 1975 and then further reduced to 400 I.U. per day in 1992. For comparison, in the USA it has been 200 I.U. a day and recently it has been raised to 400 I.U. a day. This reduction in the daily allowance had no scientific basis except the observation that this amount of vitamin D is present in a teaspoonful of cod-liver oil which has long been considered safe and effective in preventing rickets.
In the last decades, the incidence of Type 1 diabetes in Finland has been climbing, which is most likely related to the decrease in the daily recommended allowance of vitamin D. As of 1999, Finland has the highest reported incidence of Type 1 diabetes in the world (16). In Finland, the yearly sunshine (and therefore vitamin D skin synthesis) is much lower compared to more southern areas. Therefore, the population in Finland is at even higher risk for vitamin D deficiency.
In another excellent study (17), researchers found vitamin D supplementation during infancy can significantly reduce the risk for developing Type 1 diabetes. This study was carried out in seven centers in different countries across a variety of populations in Europe.
Autoimmune Thyroid Diseases
Autoimmune thyroid disease has a wide range of manifestations: It is the most common cause of underactive thyroid (technically known as hypothyroidism). In some individuals, it can cause overactive thyroid (technically known as hyperthyroidism). When autoimmune thyroid disease causes underactive thyroid, it is called Hashimoto’s thyroiditis and when it causes overactive thyroid, it is called Graves’ disease .
The usual symptoms of underactive thyroid are fatigue, weight gain, mood disorders, dizziness, muscle cramps, cold intolerance, hair loss, frequent menses and memory loss.
The usual symptoms of overactive thyroid are: irritability, hyperactivity, heart palpitations, tremors, shakiness, excessive sweating, heat intolerance, weight loss, bulging eyes, infrequent menses, osteoporosis, anxiety and panic attacks. Rarely, patients can develop psychotic symptoms such as hallucinations, delusions and irrational behavior. Sometimes patients can have predominant eye symptoms such as watery, bulging eyes and double vision. Very rarely, patients can also have excessive thickening and swelling of their skin in the lower legs.
If hypothyroidism or hyperthyroidism remains untreated for a long period of time, a person can lapse into a coma and death can occur.
Typically, physicians treat underactive thyroid by giving thyroid hormone in the form of a pill. In the case of overactive thyroid due to Graves’ disease, we either give an anti-thyroid drug or destroy the thyroid gland by exposure to radioactive iodine. Almost all Graves’ disease patients treated with radioactive iodine end up with underactive thyroid (hypothyroid). They then need to take a thyroid hormone pill for the rest of their life.
In medical literature, genetics is the main factor recognized as the contributory factor for causing autoimmune thyroid disease and of course, there’s nothing you can do about that. However, I check vitamin D level in all of my patients with autoimmune thyroid disease- Graves’ disease as well as Hashimoto’s thyroiditis- and find it to be low in all of them. I treat them with a high dose of vitamin D. As the vitamin D level rises, thyroid antibodies start to come down. I am convinced that vitamin D deficiency is a major factor causing autoimmune thyroid disease. Interestingly, in an experimental study (18) from the University of California- Los Angeles (UCLA), USA, vitamin D deficiency was found to cause Graves’ disease in laboratory animals. In an excellent clinical study (19) from Diskapi Yildirim Beyazit Training and Research Hospital, Turkey, researchers found that vitamin D level was low in all of their Hashimoto’s thyroiditis patients. In addition, they observed the lower the vitamin D level, the higher the thyroid antibody level in these patients with Hashimoto’s thyroiditis.
In addition to vitamin D deficiency, I find two other factors to be commonly present in patients with autoimmune thyroid disease. These are: fear and a high carbohydrate diet. Both of these factors are the other major causative factors for autoimmune thyroid disease.
Based on these observations, I developed a new, effective strategy to treat Hashimoto’s thyroidits as well as Graves’ disease. I have seen some amazing results in these patients. To learn more in this regard, please refer to my books, “Graves’ Disease And Hyperthyroidism” and “Hypothyroidism And Hashimoto’s Thyroiditis.”
Inflammatory Bowel Disease (IBD)
Inflammatory Bowel Disease (IBD) is a chronic disease of the intestines which not only diminishes quality of life, but often results in debilitating complications.
There are two main clinical forms of IBD : Ulcerative colitis and Crohn’s disease .
The usual symptoms are: bloody diarrhea, abdominal cramping, excessive gas, weight loss and fatigue.
Complications of IBD include: perforation of the intestines, fistula formation, intestinal obstruction and colon cancer.
The medical treatment for IBD patients consists of a wide array of drugs, all of which aim to reduce inflammation of the intestines. Most patients receive high doses of steroids, with their serious side-effects including reduction of vitamin D level. Many of the other drugs also have serious side-effects, such as risk for tuberculosis, renal failure and lymphoma.
Despite use of these drugs, patients often continue to have relapses of symptoms. Many patients end up losing part their intestines. Colon cancer is also much more common in patients with ulcerative colitis than in the general population.
To me, the current treatment is a band-aid approach. We physicians keep trying to suppress inflammation by one drug or another without examining the very basic question: What is the real cause for the inflammation and what can we do to treat this root cause? Based on my own clinical experience and extensive scientific studies in this field, I developed a deeper approach for treating my patients with IBD, discussed later in this chapter. First, let’s investigate the relationship between IBD and low vitamin D.
The Link Between IBD And Vitamin D Deficiency
Vitamin D is almost always low in patients with IBD. As we know, low vitamin D leads to malfunction of the immune system. It is intuitive to conclude that Vitamin D deficiency plays a vital role in the development and progression of IBD. Once IBD develops, patients often spend more time indoors, in hospitals and recovering at home which further lowers their vitamin D level.
In addition, the small amount of vitamin D that people get from their food is also lost in patients with IBD due to intestinal malabsorption. Consequently, vitamin D level in these patients drops even lower. Low vitamin D further impairs the immune system and thus a vicious cycle starts: low vitamin D causes IBD, which causes further reduction in Vitamin D, which then causes further disruption of the immune system and more progression of IBD.
Can Vitamin D Supplementation Help Patients With IBD?
The answer is yes!
One experimental study (20) from The Pennsylvania State University, University Park, USA, showed that vitamin D can prevent the symptoms of experimental IBD. In an excellent clinical study from (21) the University Hospital Bratislava, Slovakia, the researchers found that vitamin D supplementation with high doses to bring 25-OH vitamin D level above 50 ng/ml, significantly improved the health-related quality of life in their patients with Ulcerative Colitis and Crohn’s disease. But supplementation with low dose of 800 IU per day did not have any clinical benefits. This finding is in line with my observations at the Jamila Diabetes and Endocrine Medical Center. I aim a level of 25-OH vitamin D to be at least 50 ng/ml in my patients. How to achieve this level is discussed in Chapter 26: Treatment Of Vitamin D deficiency.
My Approach To The Treatment Of Autoimmune Diseases.
I do treat the symptoms of an autoimmune disease with traditional medical practices such as giving thyroid hormone to underactive thyroid patients. However, I also look deeper and treat factors that resulted in the development of the autoimmune disease in the first place. If you don’t treat the underlying cause of immune dysfunction, it will continue to erupt to the surface in the form of another autoimmune disease.
In medical literature, it is well known that a person with one autoimmune disease is at high risk for developing other autoimmune diseases.
What Causes Autoimmune Diseases?
1. Genetics
Autoimmune diseases tend to congregate in families. You’re at high risk for developing an autoimmune disease if you have a family history of these diseases. However, not every genetically predisposed individual (not even twins) develops an autoimmune disease. Acquired factors play an important role in bringing out the disease in these individuals with a genetic predisposition. These acquired factors are discussed below.
2. Vitamin D Deficiency
As I have elaborated in this chapter, there is strong evidence to incriminate low vitamin D as an important factor in the causation of autoimmune diseases.
3. Diet
Extensive scientific studies have clearly established that diet plays an important role in the causation and progression of autoimmune diseases. Certain genetically predisposed individuals are not able to digest starches and sugars properly. The partially digested starches and sugars provide fertile grounds for bacteria and yeast to thrive in the intestines, causing “bacterial overgrowth.” The byproducts of these micro-organisms cause inflammation of the intestinal walls, making them more permeable. Large molecules of partially digested food can then leak into the blood stream. This is called Leaky Gut Syndrome , which in turn, activates your immune system unnecessarily which then starts to malfunction. Therefore, starches and sugars play an important role in causing and perpetuating autoimmune disease.
4. Stress
Stress is a well known factor in the causation of autoimmune disease. Stress, especially in the form of fear, causes your body to produce excess amounts of cortisol, a hormone produced by the adrenal glands. An excessive amount of cortisol is known to weaken the immune system.
Based upon the four factors described above, I give the following advice to my patients with autoimmune diseases. Genetics, of course, you can’t change but you can do a lot about the other three factors.
Vitamin D Supplements
Check your vitamin D level (for details please refer to Chapter 25, Diagnosis of Vitamin D Deficiency). Aim to keep your vitamin D level between 50 and 100 ng/ml (125 nmol/L to 250 nmol/L). To achieve these levels, most people require vitamin D supplementation in large doses (See Chapter 26, Treatment of Vitamin D Deficiency).
Special Diet
WHAT NOT TO EAT
1. No processed food
No canned foods, snack bars, or pre-cooked dinners. Have fresh foods, real foods and organic foods. The true nutritional value of a food (compared to what is written on the food label) is lost when it is processed, stored or frozen. Try to grow your own vegetables and fruits. In addition, use a local farmer’s market to buy fruits and vegetables. Remember, if a fruit or vegetable has traveled hundreds, if not thousands of miles, it has lost its true nutritional value.
2. Eliminate Starches
Starches are refined carbohydrates. What is a carbohydrate? In chemical terms, a carbohydrate consists of carbon, hydrogen and oxygen atoms.
As a dietary source, carbohydrates are divided into three types:
A. Monosaccharides , which consists of only one type of simple sugar, such as glucose or fructose. A monosaccharide does not require any further breakdown in the intestines before its absorption into the blood.
B. Disaccharides , which consists of two molecules of monosaccharide bonded together. For example, table sugar (sucrose) consists of glucose and fructose. Milk sugar (lactose) consists of glucose and galactose. A disaccharide requires further breakdown in the intestines before it can be absorbed into the blood. For example, sucrase, an enzyme in the intestinal wall, breaks down sucrose into glucose and fructose. Lactase, another enzyme in the intestinal wall, breaks down lactose into glucose and galactose.
C. Polysaccharides , which consists of hundreds to thousands of glucose molecules bonded together. During normal digestion, these polysaccharides are broken down into glucose, which is then absorbed into circulation. Digestion of polysaccharides is a complex process, which requires several digestive enzymes, including maltase in the small intestines.
A lot of individuals with Autoimmune diseases cannot properly digest polysaccharides due to deficiency of the specific enzymes in the intestines. Partially digested polysaccharides become a great food for bacteria and yeast to grow, which leads to bacterial overgrowth and Leaky Gut Syndrome.
The main polysaccharides in our diets are starches. Therefore, eliminate all starches from your diet. Starches include wheat, rice, oats, barley, rye, corn, potatoes, sweet potatoes and yams.
There is another polysaccharide in our diet, called cellulose, which cannot be broken down in human intestines. Therefore, it does not become food for bacteria. Cellulose is our dietary fiber, an important ingredient for our health. It prevents rapid absorption of glucose, lowers cholesterol and forms bulk for the stools to prevent constipation.
It is interesting to note that in nature, plants contain carbohydrates as starch, cellulose and simple sugar, mainly fructose. After a plant is harvested, it goes through processing which gets rid of cellulose and what is left behind is starch. Therefore, we refer to starches as refined carbohydrates.
Some individuals with Autoimmune dysfunction even develop loss of the intestinal villi, which are finger-like projections on the intestinal surface that are extremely important for digestion and absorption of polysaccharides. This is what we call Celiac disease or Gluten Sensitivity. There is a blood test to diagnose Celiac disease. The blood test aims to detect several special antibodies, called anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). Consider having this test done. If the test for Celiac disease is positive, then you should stay on a Gluten-free diet for the rest of your life. A Gluten-free diet means to eliminate all wheat, barley, oats and rye from your diet. You need to read labels carefully.
3. Say No to Sugar, Sugar Substitutes and Sugar Alcohols, but Yes to Honey
Say goodbye to sugar, even brown sugar and sugar-containing food items. Why? Sugar causes Leaky Gut Syndrome. This is how: A sugar molecule consists of glucose and fructose. During digestion, each sugar molecule has to be broken down into glucose and fructose by an enzyme called sucrase, before it can be absorbed from the intestines into the blood. A lot of individuals with Autoimmune Dysfunction do not have enough sucrase to digest sugar. Undigested sugar then serves as fertile ground for bacterial overgrowth in the intestine, which can lead to Leaky Gut Syndrome. As a result, there is unnecessary stimulation of the immune system, as I explained earlier.
You can use honey as a sweetener, because each honey molecule consists of only glucose. It does not require any breaking down in the intestines before its absorption into the blood.
Avoid artificial sweeteners such as Sucralose (Splenda), Saccharin (SugarTwin, Sweet’N Low), Aspartame (Equal, NutraSweet), Acesulfame (Sunett, Sweet One) and Neotame.
Also beware of sugar alcohols such as Sorbitol, Mannitol, Xylitol, Lactitol, Maltitol, Erythritol, Isomalt, Hydrogenated starch hydrolysates (HSH).
These artificial sweeteners are widely used in processed foods, including sodas, powdered drink mixes, chocolate, cookies, cakes, chewing gum and candies. These products are typically marketed as sugar-free and low calorie, which obviously has great appeal to the general public.
As a general rule of thumb, stay away from all processed food items. These are NOT natural, regardless what they claim. These are synthetic substances that may have started out from a natural substance, but the final product is far from anything that exists in nature. For example sucralose (in Splenda) is made when sugar is treated with trityl chloride, acetic anhydride, hydrogen chlorine, thionyl chloride and methanol in the presence of dimethylformamide, 4-methylmorpholine, toluene, methyl isobutyl ketone, acetic acid, benzyltriethlyammonium chloride, and sodium methoxide, according to the book Sweet Deception. This processing obviously makes sucralose unlike anything found in nature.
Artificial sweeteners and sugar alcohols can give rise to a number of side-effects, including gas and abdominal cramping. Why? Because these chemicals are usually not absorbed properly and become a fuel for bacterial overgrowth in the intestines. Some even cause neurologic symptoms such as confusion, headaches or dizziness. In addition, there are serious concerns about their long term safety.
Avoid any food item that contains high fructose corn syrup, as it provides fuel for the growth of bacteria in the intestines and contributes to Leaky Gut Syndrome. In addition, it also leads to obesity, diabetes, heart disease and liver damage.
Here are some common food items you should avoid because they are loaded with starches and sugar or sugar substitutes.
Bread, rice and pasta. Bread includes white bread, whole wheat bread, sourdough bread, French or Italian bread, bagels, croissants, biscuits, hamburger buns, rolls, pita, Indian naans, tortillas, tacos and many more similar bakery products.
Potato chips, Nachos, French fries.
Rice including white, brown as well as wild rice.
Waffles, pies, donuts, pancakes, pastries, cookies, candy and cakes.
Chocolate, cereals, pizza, chewing gum.
4. No Sodas, No Fruit Juices and No Alcohol.
Do not drink any sodas, even diet versions. Why? Because sodas are loaded with high fructose corn syrup and sugar. Diet sodas use artificial sweeteners and sugar alcohols.
Also avoid fruit juices, because fruit juices from grocery stores contains only a small amount of real juice and a lot of sugar water. Avoid even freshly squeezed, natural juice. Why? Because you end up consuming a high amount of natural sugar, fructose. For example, instead of eating just one whole orange, you will have to use 3-4 oranges to get about a cup of pure orange juice.
Instead of fresh juice, eat two to three Fresh fruit servings per day. Why? Because whole fruits not only contain sugar (fructose), but also the pulp, which slows down the absorption of sugar. That’s why there is less of a rise in blood sugar level after eating a whole fruit, as compared to fruit juice, which causes a rapid rise in blood sugar level.
Avoid alcoholic beverages. Why? Because alcohol is a medically well known toxin for the liver, pancreas, brain and nerves. In addition, alcoholic beverages contain carbohydrates and sugars. For example, most beer comes from malted cereal grains, most commonly malted barley and malted wheat.
WHAT TO DRINK?
Water should be your beverage of choice. In a restaurant setting, order water for your drink. Many people order a soda or a dessert in a restaurant under peer pressure. Remember your body has not changed because you are in a restaurant.
WHAT TO EAT?
1. Vegetables
For clarification, when I use the term vegetables, I refer to the leaf and stem part of the plant, excluding the roots (such as potatoes, sweet potatoes and yam), which are basically starches.
Eat plenty of vegetables. Include vegetables in every meal. They are a great source of vitamins, minerals and fiber. They are bulk forming, fill up your stomach and satisfy your appetite. They also slow down the absorption of sugar from carbohydrates in your diet.
In general, vegetables contain only small amounts of carbohydrates, which is usually fiber. For example, 1/2 cup of cooked spinach contains only 3 gm of carbohydrates, out of which 2 gm is fiber. Spinach, like many other green leafy vegetables, is a great source of Vitamin A, Vitamin K and Manganese.
Use fresh vegetables of the season. Get them from your own vegetable garden or from a farmers’ market. Try to steam them or lightly fry in olive oil.
Use raw vegetables in your salads, such as cucumber, bell pepper, spinach and tomatoes.
2. Fruits
Eat one to two fresh fruits or 1/2 cup per day. Always use fruits which are in season. Either get them from your own fruit trees or from a farmers’ market. Avoid fruits and vegetables which have traveled all around the world.
There is tremendous wisdom why certain fruits and vegetables grow in a certain season and climate. We humans may never be able to comprehend this wisdom. Suffice it is to say that if you live in sync with nature, you will avoid a lot of health problems.
For example, nature produces summer fruits for people in a particular area who are also experiencing summer temperatures. Now, you may be in the winter season, but your grocery store is loaded with summer fruits, brought thousand of miles away from the other side of the equator. Without thinking, you grab these produce items as novelty items. Remember fruits and vegetables are just foods, not items for mental entertainment or ego enhancement.
In general, fruits are a great source of vitamins and minerals, especially potassium. Fruits contain carbohydrates, but they are mainly simple sugars, fructose, which are easily absorbed from the intestines, because they do not require any further breakdown.
Fruits are a great source of antioxidants. In this way, they help to neutralize the damaging effects of free oxygen radicals that are released as a byproduct of the metabolism of food in the cell or when the body is exposed to cigarette smoking or radiation. These free oxygen radicals can damage the structures inside the cell. This is called oxidative stress and it may play a significant role in causing diseases such as cancer and heart disease. Anti-oxidants help to neutralize oxidative stress. Anti-oxidants consists of Beta-carotene, Vitamin A, Vitamin C, Vitamin E, Lutein, Lycopene and Selenium.
Brightly colored fruits are loaded with anti-oxidants. Fruits that are highest in antioxidant contents are pomegranate, blueberries, strawberries, cranberries, cherries, dates, plums, oranges, apples and pineapples.
Fruits are also a good source of fiber, especially avocados, apple, pear, guava, dates, cherimoya, pomegranate, passion fruit, blueberries, blackberries, raspberries, mango, orange, figs and kiwi fruit.
Avocado, guava, dates and cherimoya are a great source of protein. Avocados are also loaded with omega 3 fatty acids, vitamins C and E, carotenoids, selenium, zinc and phytosterols, which help to protect against heart disease and inflammation.
3. Nuts/Seeds
Nuts and seeds are an excellent source of nutrition. They are a great source of Monounsaturated Fatty Acids (MUFA) and omega-3 polyunsaturated fatty acids. Together, these are called the good fats. Why? Because these fats help to increase good (HDL) cholesterol and lower bad (LDL) cholesterol.
Nuts are also a good source of protein, vitamin E (an anti-oxidant) and fiber. They are also low in terms of carbohydrates. For example, 100 gm of almonds provides you with 21 grams of protein, 12 grams of fiber and only 20 grams of carbohydrates. Compare it to 100 grams of Quinoa, which provides you with roughly 13 grams of protein, 6 grams of fiber and 69 grams of carbohydrates.
Nuts are also packed with vitamins and minerals such as magnesium, phosphorus, potassium, selenium, manganese, folate, copper, calcium and zinc. In addition, nuts contain phytosterols, such as flavonoids, proanthocyanidins and phenolic acids.
There is mounting evidence to show that nuts may reduce oxidative stress and inflammation. Clinical studies show that nuts can reduce the risk of heart disease, age-related brain dysfunction and diabetes.
Almonds, pine-nuts, pistachios and peanuts contain more protein than other nuts. Macadamias contains the highest amount of monounsaturated fatty acids, followed by hazelnuts, pecans, almonds, cashews, pistachios and Brazil nuts. Walnuts contain the highest amount of polyunsaturated fatty acids, followed by Brazil nuts, pecans, pine nuts, pistachios, peanuts, almonds and cashews.
Nuts also contain a small amount of saturated fat, the so called bad fat. Almonds contain the least amount of saturated fat and Brazil nuts the highest. While all nuts contain some selenium, Brazil nuts have the highest quantities. Selenium is a good antioxidant, helps the immune system and may prevent some cancers.
Pine nuts are one of the richest sources of manganese, which is an important co-factor for the anti-oxidant enzyme, superoxide dismutase. Consequently, pine nuts are good anti-oxidants. In addition, pine nuts contain the essential fatty acid pinolenic acid, which works as an appetite-suppressant by triggering the hunger suppressant enzymes, cholecystokinin and glucagon-like peptide-1 (GLP-1) in the small intestine.
Technically, peanuts are not actually nuts but legumes. Dry beans, peas and lentils are some other examples of legumes.
Like nuts, seeds are a good source of protein. For example, 100 grams of seeds will provide you with 30 grams of protein. Seeds are an excellent source of the amino acids tryptophan and glutamate. Tryptophan is converted into serotonin and niacin. Serotonin is an important regulator of our mood. Low serotonin can lead to depression. That’s why many modern anti-depressant medications, such as Prozac, Zoloft, Paxil, Celexa and Lexapro act by increasing the level of serotonin in the brain. Glutamate is a precursor for the synthesis of γ-amino butyric acid (GABA), which is an anti-stress neurotransmitter in the brain and can help to reduce your anxiety.
Like nuts, seeds are also loaded with vitamins and minerals. Pumpkin seeds can block the action of an androgen, DHEA (Dehydroepi-androsterone). This may be helpful in preventing prostate and ovarian cancers.
With so many health benefits, I recommend nuts and seeds to all of my patients with Autoimmune Disorders. However, nuts can cause you to gain weight. Therefore, use nuts in small amounts.
Use raw nuts and seeds. Do not use salted, sugar-coated or chocolate-coated nuts or seeds for obvious reasons.
4. Meats/Poultry/Fish
Eat meats, poultry and fish, including shell fish. These are excellent sources of protein, vitamins, minerals and contain no carbohydrates. For example, 1 oz (28 grams) of cooked Atlantic salmon contains 6 grams of protein, 3 grams of fat, is loaded with Omega 3 fatty acids, and is also a good source of Thiamin, Niacin, Vitamin B6, Phosphorus, Vitamin B12 and Selenium.
Red meat is an excellent source of protein, iron and vitamins, especially vitamin B12. For example, 1 oz (28 grams) of ground Beef, (95% lean meat/5% fat, crumbles, cooked, pan-browned, hamburger) contains 8 grams of protein, 2 grams of fat, and No carbohydrates or sugar. It does contain 20 mg of cholesterol which is only 7% of the daily recommended value. Compare it to 1 oz (28 grams) of cooked Quinoa which contains only 1 gram of protein, 1 gram of fat and 6 grams of carbohydrates, but no cholesterol.
Weight for weight, Quinoa contains only 1/8 of the amount of protein present in beef, but carries the myth of being the best source of protein in the mind of many people. Amazing!
Eat red meat 2 - 3 times per week. Select lean cuts. Avoid processed meats such as cold cuts, salami and hot dogs, as these often contain added sugar and carbohydrates.
Eat Chicken and/or turkey once a day. These are great sources of protein and vitamins.
Eat Fish 1 - 2 times a week. In addition to providing you with protein and vitamins, these are great source of Omega-3 fatty acids, which are good for your cardiovascular health. However, overconsumption of fish can lead to mercury poisoning.
Remember, vitamin B12 is lacking in plants. Therefore, you often become low in vitamin B12 if you are on a vegan OR vegetarian diet.
5. Dairy
Eat a cup of regular, plain yogurt everyday. It is a great source of healthy bacteria for our intestinal health. It is also a good source of protein and calcium as well.
Include a moderate amount of cheeses in your diet. If you are trying to lose weight, then limit the use of cheese.
Drink a cup of milk per day, provided you are not Lactose Intolerant, which is more prevalent in patients with Autoimmune diseases. If you have Lactose intolerance, you should try Almond milk.
A lot of individuals with lactose intolerance do well on yogurt and cheeses.
6. Eggs
Eggs are a great source of protein, vitamins and minerals, especially Riboflavin, Vitamin B12, Phosphorus and Selenium. Eggs contain no carbohydrates. Therefore, they are a great nutritional source for people with Autoimmune disorders.
People are overly concerned about the cholesterol content of eggs. Cholesterol is present in the yolk of the egg. If your LDL cholesterol is elevated, then you should use only egg whites.
HOW TO EAT?
Eat three regular meals per day. Dinner should be the lightest meal of the day, lunch the heaviest and breakfast the modest meal. Eat dinner at least 3 hours before bedtime.
Avoid snacks, especially when you’re watching TV or working on a computer. If you absolutely must have a snack, then try something like nuts, carrot sticks or other raw vegetables.
Get involved in your food. Read labels on food while you are in the grocery store. You’ll be surprised how many food items contain sugar, fructose syrup and corn syrup. Avoid these food items.
Try to prepare your meal yourself, at least over the weekend. Avoid buffets! When you opt for a buffet meal, you want to get the most for your buck (after all, you’re only human) and you generally end up overeating. Try to eat at home as much as possible.
If you are trying to lose weight, keep a diary of the food you eat. You may be amazed at how much you really eat, contrary to what you thought.
Eat when you are hungry, not because you’re sad or on a computer or you have to socialize with family members and friends. People often eat because of psycho-social reasons. That’s why they continue to gain weight.
Be aware of your eating habits. Eat slowly and enjoy every bite of your meal. Don’t watch TV while eating. Many people overeat because they get too involved in watching a TV show or reading a newspaper and don’t keep track of their food intake.
Read these recommendations frequently. This will serve as a reminder. Watch your conditioned mind and see how it tries to lure you to eat foods that you know you should not eat. Be aware of the inner voice such as, “Reward yourself. You deserve this bowl of ice-cream. Eat whatever because you’re at a party.” The inner voice comes from your conditioned mind, which is the basis of your old, bad, illogical eating behavior. You need to rise above it, simply by observing the inner voice, which actually is your enemy in the sense that it sabotages your health.
Practical Suggestions for Meals
Breakfast:
Egg white omelet using 2-3 egg whites only.
OR
2-4 hard boiled eggs (egg whites only).
1/2 to 1 cup of yogurt.
A cup of coffee or tea or milk.
Lunch / Dinner:
A cup of coffee or tea.
A bowl of vegetable soup.
A plate of grilled chicken and fresh garden salad (you may add salad dressing).
A fresh fruit such as a small apple
OR
A cup of coffee or tea.
A bowl of vegetable soup.
A small chicken or turkey or tuna sandwich. Discard the top slice of bread and make it an open sandwich.
A fresh fruit such as a small apple.
OR
Grilled vegetables such as bell pepper, zucchini or eggplant, with chicken or turkey strips stir fried.
A fresh fruit such as a small apple.
OR
Grilled Chicken or Steak.
A small baked potato (without butter or sour cream).
A fresh fruit such as a small apple
OR
Shrimp with vegetables on a small bed of pasta.
A fresh fruit such as a small apple
OR
A bowl of soup.
Fish, grilled or baked, especially Salmon.
A fresh fruit such as a small apple
OR
6 inch turkey or chicken Subway sandwich. Discard the top slice of bread, and make it an open sandwich.
A fresh fruit such as a small apple.
ETHNIC FOODS
Chinese
A cup of won ton soup.
Beef or chicken or shrimp, cooked any Chinese style.
A fresh fruit such as a small apple
OR
Mongolian barbeque beef or chicken.
A fresh fruit such as a small apple.
Japanese
2-3 sushi. Avoid rice rolls.
Stir fried beef or chicken.
A fresh fruit such as a small apple.
Mexican
A cup of vegetable soup.
A plate of chicken or beef fajitas.
A fresh fruit such as a small apple.
Indian/ Pakistani
Two pieces of Tandoori chicken.
Mixed vegetables.
A fresh fruit such as a small apple
OR
Two Seekh Kebobs.
A plate of vegetables such as okra, spinach, or eggplant.
A fresh fruit such as a small apple.
OR
A small portion of chicken or beef or lamb curry, mixed with vegetables. For example, lamb saag or lamb okra or chicken jalfrezi.
A fresh fruit such as a small apple.
Middle Eastern
Chicken or beef kebob and salad.
A fresh fruit such as a small apple.
OR
Chicken shawarma.
Grilled vegetables.
A fresh fruit such as a small apple.
Greek
Greek salad.
Gyro meat (no fries or rice).
A fresh fruit such as a small apple.
Stress Management
A discussion about stress and its management could fill a book – literally. Here is a brief overview of my strategy to manage stress.
What I have discovered is that patients with autoimmune diseases worry a lot, about every little thing. When you worry, your body thinks that it is under attack. The immune system, therefore, gets into a high alert state to fight off the offending agent. But there is no one to fight off! Confused, it starts to attack its own organs, causing a variety of diseases.
Why do we worry? Use logic and you will realize, the underlying cause of “worrying” is fear .
The Origin Of Fear
What is the origin of fear? It originates when you’re thinking about the future. I call it the “What If Syndrome.”
If you look at your fear closely, you’ll understand its true origin. You realize that you’re holding on to some negative experience of your own or of other people (Maybe you read about it or saw it on T.V.). You do not want it to happen to you ever, because it was (or could be) so painful. The mere thought that it may happen triggers a wave of fear and anxiety in you. Fear causes a release of adrenaline and cortisol from your adrenal glands. Both of these hormones damage your body. Adrenaline raises your blood pressure, increases your heart rate and may even cause chest tightness and chest pain. Cortisol plays havoc on your immune system.
So, How Can I Be Free Of Fear?
You can be free of fear if you use logic. Obviously “what if” or “what may’ is a creation of your own mind, isn’t it? It may or may not happen. It’s not a problem in reality, not happening at this moment, right? Therefore, it’s a phantom, an illusion. If and when it happens, at “that time, the present moment,” you’ll be able to take care of it.
For example, you’re stuck in traffic on your way to the airport and there’s nothing you can do about it. You start worrying. “What if I miss my flight and then I’ll miss my interview for this job I really want and my best chance to get this dream job will evaporate” and on and on. You get so fearful from the drama that your mind creates that you may end up having chest tightness and pain and find yourself heading to a hospital. Or you can choose not to think about ‘what if,’ but instead stay in the present moment, focus on your driving and arrive at the airport safely. You may or may not be late. If you are late, you will deal with it. Therefore, live in the Now, stay in reality and you won’t have any fear.
Take action in the present moment. For example, eat right, exercise regularly and take vitamin D every day. There’s a good chance you won’t develop diabetes. However, if you just keep worrying about diabetes and don’t take any actions, you may develop diabetes. Take real action in the present moment and don’t worry about the results.
In summary, autoimmune dysfunction is a complex process and medications are a very superficial approach. Treat your autoimmune disorder at its roots by : a good dose of vitamin D, special diet and in-depth stress management.
Please refer to my book, “Stress Cure Now” for a more detailed stress management.
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