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What is the best diet for autoimmune diseases

June 21, 2017
What are some foods have anti-inflammatory properties?

In recent years there’s been a lot of talk about the autoimmune diet. But what exactly is an autoimmune diet and which foods have anti-inflammatory properties?  These are some of the most common questions my patients ask me in clinic.  Essentially, what foods help autoimmune diseases?  In certain cases, it’s pretty cut and dry.  If you have celiac disease, avoid gluten.  If you have ankylosing spondylitis, Crohn’s disease, or ulcerative colitis, try to follow the FODMAP diet.  There already exists evidence-based research that supports these interventions.

But what about other autoimmune diseases like rheumatoid arthritis, lupus, Sjogren’s syndrome?  What should you be eating if you have any of these?  Do they have their own autoimmune diet?  Should you avoid nightshades, dairy, gluten, eggs, etc.  In recent rears a myriad of “anti-inflammatory diets” have surfaced on the web.  For the most part, they are supported by little if any evidence-based research.  This is unsurprising.  Good quality research requires money.  Lot’s of money… pharma money.  It simply does not make any business sense for these companies to fund large and expensive studies that have no commercial potential.  Believe me, I am not defending big pharma, I’m simply stating reality.

What is epigenetics?

Even though we do not have great scientific evidence supporting a particular autoimmune diet or foods to prevent, cure, or lessen autoimmune diseases, it’s kind of obvious that some lifestyle practices lead to better health outcomes.  Take smoking.  People that smoke tend to get lung cancer and develop heart disease compared to those that don’t smoke.  But how does that work exactly?

Everyone is born with genes.  Some of these genes are active and some remain dormant.  Your genotype is the entire makeup of your genes.  Your phenotype is the result of how your genetic material is expressed.  For example, you may have the genes for blue eyes and brown eyes.  If the genetic material for brown eyes is dominant, you’ll have brown eyes.

This is where it gets really interesting.  Over the course of your lifetime, some of your genes are turned on and off.  This is influenced by factors like aging, the environment, and lifestyle.  Epigenetics is the study of how genes are turned on and off based on external influences.

Epigenetic changes can be good but can also cause harm.  We think that some of these changes can result in autoimmune diseases.  It’s important to remember that epigenetics is in its infancy.  Researchers still are not 100% sure how this happens, let alone, how to specifically manipulate the environment to cause favorable epigenetic change.

Autoimmune diet: what foods should I eat?

This simple answer to this question is, “I don’t know”.  One day, when researchers crack the epigenetic code, I may be able to answer this questions more accurately.  I may be able to tell you, if you follow the rheumatoid arthritis autoimmune diet, this should help control your inflammation.  Unfortunately, I am unable to say that yet.

But like I was saying at the beginning of this post, some people who adhere to certain lifestyle practices tend to be healthier.  Given we don’t really have actionable epigenetic data to guide lifestyle choices, the goal when it comes to nutrition and lifestyle is to adopt habits that have a tendency to result in overall general health to live happier, healthier, and longer.

The Blue Zones®

The Blue Zones® are 5 regions in the world where people statistically people tend to live to 100 years AND who tend to reach this age in health.  The project spawned from the National Geographic Society.  The goal was to find “hot spots of longevity” around the world.  The researchers identified 5 zones and circled them in blue ink.  These regions are as follows:

  • Ikaria, Greece
  • Okinawa, Japan
  • Ogliastra region, Sardinia
  • Loma Linda, California
  • Nicoya Peninsula, Costa Rica

One would think that there are no similarities between people living in Japan versus people in Greece.  What the researchers identified was a core list of lifestyle practices and environmental factors that shared between all the different regions.

The Power 9®

Move Naturally

People that live to 100 years don’t necessarily run marathons or go the gym.  They are always on the go and they move naturally.  For example, they tend a garden, they walk to the market, they use stairs instead of the elevator.


People that live in the Blue Zones live with purpose.  They wake up every morning, and they know “why I wake up in the morning”.  Having a clear purpose in life can add an extra 7 years of life expectancy.

Down Shift

We all know that stress can cause inflammation.  I often see people in my clinic who’s rheumatoid arthritis was in perfect control until something really bad happened, like a divorce, job loss, or a death in the family.  Chronic stress leads to chronic inflammation.  People in the Blue Zones develop daily habits to help reduce stress.

80% Rule

The Japanese have a saying “Hara hachi bu”.  This is a mantra that Okinawans say before every meal, reminding them to stop eating when they feel about 80% full.  There is a delay between feeling full and actually being full.  When you feel 80% full, you are actually full.  So if you stop eating when you feel full, you are overeating.  People living in the Blue Zones tend to eat their largest meal at breakfast and their smallest meal at dinner.

Plant Slant

Although not all regions of the Blue Zones eat meat, their diets all mainly consists of fresh veg and beans.  Lot’s of beans: fava, soy, lentils, etc.  They eat meat very sparingly and servings are small, “about the size of a deck of cards”.

Wine @ 5

Thank goodness for this one!  People in the Blue Zones, expect for Adventists, drink alcohol moderately and regularly.  Typically, they drink 1-2 glasses of wine per day with friends and family at the end of the work day.  They found that people who drink regularly and moderately tend to live longer than those who don’t.


Almost all people who live until 100 tend to belong to some sort of faith-based community.  They found that attending a service 4 times a month can add up to 4 – 14 years of life expectancy.

Loved Ones First

People living in Blue Zones tend to live close to their families.  It’s common to have children, parents, and grandparents living under the same roof.  They also tend to commit to a life partner.

Right Tribe

People in the Blue Zones keep strong social networks.  Not only are these social strong, but they also foster healthy behaviors.  Women in Okinawa create “moais” early on in life.  These are groups of 5 friends that are completely committed to each other for life.

The true beauty in the Blue Zones Project® is that you don’t need to live in a Blue Zone to reap the benefits.  By living the Power 9® you can set yourself up to live with vitality to a ripe old age.


Medications certainly have made a huge difference in the prognosis of many autoimmune diseases like rheumatoid arthritis and lupus but it’s not enough.  By integrating healthy habits we can potentially turn on an and off genes that contribute to ongoing autoimmunity and inflammation.  Although we still don’t know exactly what the perfect autoimmune diet is, by adopting healthy habits set forth by the Power 9®, you can increase your odds to live a long, happy and healthy life.

Diseases and Conditions

What do you mean by weight-bearing exercise?

March 22, 2017

Rheumatology primarily, and thankfully, deals with rare conditions with a few notable exceptions.  Osteoporosis being one of those.  According to the CDC

Percent of men 50 years of age and over with osteoporosis of the femur neck or lumbar spine: 4%

Percent of women 50 years of age and over with osteoporosis of the femur neck or lumbar spine: 16%

That’s a lot of people.  It’s also important note, that post-menopausal women are not the only ones that develop osteoporosis.  Men do.  People with inflammatory diseases do.  People that have GI absorption problems also do as well as people that don’t move a whole lot.

What is osteoporosis?

Osteoporosis is a condition that is characterized by weakening of bone.  People that have osteoporosis don’t feel they have osteoporosis.  It’s painless and there are no symptoms, until that is, something very bad happens like a fracture.  Bone strength is determined by bone mass and bone quality.  Think of a tree branch.  Branch A just fell off a healthy tree.  There was a bad storm and it just fell.  Structurally it’s normal.  Now you try to break it in half.  It’s a bit difficult to do.  Now you have Branch B.  This branch fell off a termite infested tree.  It’s partially hollowed out, i.e., the “wood” mass is significantly lower.  You try to break Branch B in half…easy peasy.  Osteoporosis = bone like Branch B.  Minor trauma in osteoporotic bone can result in a fracture.

Risk factors for osteoporosis

The next question is what are some of the risk factors that predispose someone to develop osteoporosis.  The good news is that some of these risk factors can be modified.  The bad news is that some risk factors cannot.

Things you CAN’T change

  • Advanced age
  • Ethnicity (white and Asian)
  • Early menopause
  • Slender build (< 127lbs)
  • Maternal history of hip fragility fracture
  • Certain medical conditions

Things you CAN change

  • Low calcium intake
  • Low vitamin D intake
  • Estrogen deficiency
  • Sedentary lifestyle
  • Cigarette smoking
  • Alcohol excess ( > 2 drinks/day)
  • Caffeine excess (> 2 servings/day)
  • Certain medications

Medical conditions

  • Rheumatoid arthritis
  • Ankylosing spondylitis
  • Lupus
  • Hyperthyroidism
  • Hyperparathyroidism
  • Alcoholism
  • Eating disorders
  • Inflammatory bowel disease
  • History of gastric bypass
  • Celiac disease
  • Renal failure
  • Multiple myeloma

There are a lot more conditions, but this is a quick list of the common ones.


  • Steroids!!! Like prednisone, methylprednisolone, dexamethasone, etc.
  • Excess thyroid meds
  • SSRIs
  • Proton pump inhibitors, used for heartburn

Before making any changes with your meds, please talk with your doctor. 

How to measure bone density?

Bone density is measured using dual energy x-ray absorptiometry (DEXA).  Just say DEXA, the first word is way too long and complicated.  Sometimes bone density can be measured with a special type of CT or ultrasound but this is not typical and usually is reserved for unusual situations.

The body parts that are typically measured are the lumbar spine, the hip, the femoral neck, and the forearm.  Sometimes the heel is also included.  These areas are best at predicting future fractures, which when you think about it, is what we’re trying to do: Prevent future fractures.

Typically, DEXAs are repeated every two years.  Again, there are some exceptions where DEXAs may be obtained more frequently.  For example, if I have a patient on a “boat-load” of steroids for systemic vasculitis for months and months on end, I may want to repeat the DEXA annually.

Why is it important to treat osteoporosis?

The answer to this question is very simple.  Prevention of fractures.  Other than the fact that fractures are incredibly uncomfortable, multiple studies have shown that fragility fractures particularly hip fractures, increase the risk of dying…  Yes you heard me, dying.  A recent article found that the one year risk of death was 23.6% after sustaining a hip fracture.  This finding is in line with most of the literature.  I don’t know about you but I don’t like these odds.

How to increase bone density?

The answer to this question is not simple.  The simple answer is eat a healthy diet, spend some time in the sun, if you smoke stop, supplement with calcium and vitamin D, regularly perform weight-bearing exercise, and medications.  The problem I have with this advice is that for the most part it is extraordinarily vague, except for the medication bit which will be covered in future posts.

What is weight-bearing exercise?

I’d like to focus on weight-bearing exercise, more specifically, what constitutes weight-bearing exercise.  I get this question a lot.

Before answering, “what is weight-bearing exercise”, we need to know what is NOT weight-bearing exercise.

Swimming is NOT weight-bearing exercise.

Cycling is NOT weight-bearing exercise.

Rowing is NOT weight-bearing exercise.

Don’t get me wrong, these exercises are excellent exercises for cardiovascular health, but they won’t help improve bone mass.  Weight-bearing exercises refers to exercises where you need to move your body against gravity.  These exercises can then be classified into high-impact and low-impact.  High-impact activities are better at building bone density but everyone has their own limits.  If you have severe osteoarthritis you may not be physically capable of performing high-impact activities.  Safety is a concern.  The National Osteoporosis Foundation has a nice list of activities.

High impact weight-bearing exercises are important but they are not the only factor in the equation.  Another major factor are falls, more specifically the prevention of falls.  Hip fractures almost always are directly caused by falls.  Having osteoporosis simply increases the risk of a fall that results in a fracture as opposed to a nasty bruise.  Some of the greatest fall risks include the following:

  • Frailty
  • Visual impairment
  • Cognitive impairment
  • Problems with your legs, this includes osteoarthritis of the knees
  • A cluttered home environment
  • A previous fall within the past 6 months.  This is actually number one on the list.

To help prevent falls, it’s important to try to correct some of the above.  It’s also important to perform activities that will help build muscle strength, balance, and mobility.  Most senior citizen exercise classes like the ones offered by the Silver Sneakers Program, focus on these types of exercises.

How much activity is necessary?

Again, this is difficult to quantify.

A recent Japanese study measured the number of steps per day continuously for 5 years and measured the bone density of participants’ heel on an annual basis.  They also measured the intensity of the activity.  After controlling for baseline density, age, and body mass, they found that bone health was optimal in elderly people who take at least 7000 to 8000 steps per day and/or spend at least 15-20 minutes per day at moderate activity.

It’s important to note that these people did not necessarily go to the gym.  Steps per day can be achieved in numerous natural different ways.  Blue Zone founder Dan Buettner has it as number #1 on the Power 9® list, MOVE NATURALLY.  If you’ve read some of my previous posts or actually heard me in clinic, you’ll know that I’m a huge fan of the Blue Zone Project.  We don’t need fancy supplements or gym memberships to achieve optimal health.  The following are a few examples on how to move naturally.

  • Walk, walk, walk.  Avoid using your car.
  • If you need to use your car, park further away.
  • Using stairs as much a possible, don’t use the escalator.
  • Start gardening.
  • Get rid of mechanical conveniences in the house.  I love my snow blower, but it has to go.

I hope that this has helped you.  If you retain only one thing, MOVE NATURALLY.  This is the secret to optimal bone health.


Disclaimer: the abovementioned information does not constitute medical advice.  Every case is unique.  Please contact your local rheumatologist or your physician for more information. 


CDC Osteoporosis Statistics

Rheumatology Secrets, 3rd edition

Guerra MT, et al. One-year mortality of elderly patients with hip fracture surgically treated at a hospital in Southern Brazil. Rev Bras Ortop. 2016 Dec 7;52(1):17-23.

National Osteoporosis Foundation

Shephard RJ, et al. Objective longitudinal measures of physical activity and bone health in older Japanese: the Nakanojo Study. J Am Geriatr Soc. 2016 Dec 9. doi: 10.1111/jgs.14553. [Epub ahead of print]



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