Autoimmune Diseases

Clinical Nutrition

Donna Plummer EdD RD

 Objectives
• Students will be able to describe the principles promoting autoimmune
diseases
• Students will be able to state risk factors for developing autoimmune
diseases
 Definition
• Autoimmunity is the activity of antibodies (which are made by B
lymphocytes) and T lymphocytes directed against normal components of a
person (autoantigens). These components are called autoantigens or self-
antigens and typically consist of proteins (or proteins complexed to
nucleic acids).
• In an autoimmune disease, the immune system mistakes part of your body,
like your joints or skin, as foreign. It releases proteins called
autoantibodies that attack healthy cells.
 Epidemiology of Autoimmune Diseases
• According to a 2014 study in autoimmunity reviews, women get autoimmune diseases
at a rate of about 2 to 1 compared to men — 6.4 percent of women vs. 2.7 percent of
men. Often the disease starts during a woman’s childbearing years (ages 15 to 44).
• Some autoimmune diseases are more common in certain ethnic groups. For example,
lupus affects more African-American and Hispanic people than Caucasians.
• Certain autoimmune diseases, like multiple sclerosis and lupus, run in families. Not
every family member will necessarily have the same disease, but they inherit a
susceptibility to an autoimmune condition.
 Epidemiology of Autoimmune diseases
• Because the incidence of autoimmune diseases is rising, researchers
suspect environmental factors like infections and exposure to chemicals or
solvents might also be involved.
• A “Western diet” is another suspected risk factor for developing an
autoimmune disease. Eating high-fat, high-sugar, and highly processed
foods is thought to be linked to inflammation, which might set off an
immune response. However, this hasn’t been proven.
 Common Autoimmune diseases
• Type 1 diabetes • Graves’ disease
• Rheumatoid arthritis • Sjogren’s syndrome
• Psoriasis/psoriatic arthritis • Hashimoto’s thyroiditis
• Multiple sclerosis • Myasthenia gravis
• Systemic lupus erythematosus • Auto immune vasculitis
• Inflammatory bowel disease • Pernicious anemia
• Addison's disease • Celiac disease
 Type 1 Diabetes
• The pancreas produces the hormone insulin, which helps regulate blood
sugar levels.
• In type 1 diabetes mellitus, the immune system attacks and destroys
insulin-producing cells in the pancreas.
• High blood sugar results can lead to damage in the blood vessels, as well
as organs like the heart, kidneys, eyes, and nerves.
 Rheumatoid Arthritis
• In rheumatoid arthritis (RA), the immune system attacks the joints.
• This attack causes redness, warmth, soreness, painful swelling and
stiffness in the joints.
• Unlike osteoarthritis, which commonly affects people as they get older,
RA can start as early as 30s or sooner.
• Over long periods of time, the inflammation associated with rheumatoid
arthritis can cause bone erosion and joint deformity.
 Psoriasis/Psoriatic Arthritis
• Skin cells normally grow and then shed when they’re no longer needed.
Psoriasis causes skin cells to multiply too quickly.
• The extra cells build up and form inflamed red patches, commonly with
silver-white scales of plaque on the skin.
• Up to 30 percent of people with psoriasis also develop swelling, stiffness,
and pain in their joints. This form of the disease is called psoriatic arthritis
 Multiple Sclerosis
• Multiple sclerosis (MS) damages the myelin sheath, the protective coating that surrounds
nerve cells, in your central nervous system.
• Damage to the myelin sheath slows the transmission speed of messages between your brain
and spinal cord to and from the rest of your body.
• This damage can lead to symptoms like numbness, weakness, balance issues, and trouble
walking.
• The disease comes in several forms that progress at different rates
• About 50 percent of people with MS need help walking within 15 years after the disease
starts.
 MS
• Wahls elimination diet —made popular by Terry Wahls, a doctor living with MS. This
diet contains some components of the Paleo diet and eliminates all grains, dairy,
legumes, and eggs
• Terry Whals had MS declined developed this meal pattern that removed inflammatory
food from diet and include numerous servings of fruits and vegetables. Had recovery.
(also had stem cell transplant)
• Reduce stress and exercise
• She conducted study with patients with MS using this diet. Patients had improvement
but not the full recovery she had.
 Whal’s Protocol
• Do eat
• Meat and fish
• Vegetables, especially green, leafy
ones
• Brightly colored fruit, like berries
• Fat from animal and plant sources,
especially omega-3 fatty acids
• Don’t eat
• Dairy products and eggs
• Grains (including wheat, rice, and
oatmeal)
• Legumes (beans and lentils)
• Nightshade vegetables, which include
tomatoes, eggplant, potatoes, and peppers
• Sugar
 Systemic lupus erythematosus SLE
• Systemic lupus erythematosus (SLE), is an autoimmune disease in which
the immune system attacks its own tissues, causing widespread
inflammation and tissue damage in the affected organs.
• It can affect the joints, skin, brain, lungs, kidneys, and blood vessels.
 SLE
• Some signs and
symptoms
 Inflammatory Bowel Disease
• Inflammatory bowel disease (IBD) is a term used to describe conditions that
cause inflammation in the lining of the intestinal wall. Each type of IBD
affects a different part of the GI tract.
• Crohn’s disease can inflame any part of the GI tract, from the mouth to the
anus.
• Ulcerative colitis affects only the lining of the large intestine (colon) and
rectum.
• Will be covered in greater detail in lecture in GI
 Addison’s Disease
• Addison’s disease affects the adrenal glands, which produce the hormones
cortisol and aldosterone as well as androgen hormones.
• Having too little cortisol can affect the way the body uses and stores
carbohydrates and sugar (glucose).
• Deficiency of aldosterone will lead to sodium loss and excess potassium in the
bloodstream.
• Symptoms include weakness, fatigue, weight loss, and low blood sugar.
• Will be covered in lecture on adrenal glands
 Graves’ Disease
• Graves’ disease attacks the thyroid gland in the neck, causing it to produce too much of
its hormones. Thyroid hormones control the body’s energy usage, known as
metabolism.
• Having too much of these hormones revs up your body’s activities, causing symptoms
like nervousness, a fast heartbeat, heat intolerance, and weight loss.
• One potential symptom of this disease is bulging eyes, called exophthalmos. It can
occur as a part of what is called Graves’ ophthalmopathy, which occurs in around 30
percent of those who have Graves’ disease
• Will be covered in lecture on hormone imbalance
 Hashimoto’s thyroiditis
• In Hashimoto’s thyroiditis, thyroid hormone production slows to a
deficiency.
• Symptoms include weight gain, sensitivity to cold, fatigue, hair loss, and
swelling of the thyroid (goiter).
 Sjogren’s Syndrome
• This condition attacks the glands that provide lubrication to the eyes and
mouth.
• The hallmark symptoms of Sjögren’s syndrome are dry eyes and dry
mouth, but it may also affect the joints or skin.
• Although you can develop Sjogren's syndrome at any age, most people are
older than 40 at the time of diagnosis.
• The condition is much more common in women.
 Sjogren’s disease
• Dry eyes. Your eyes might burn, itch or feel gritty — as if there's sand in
them.
• Dry mouth. Your mouth might feel like it's full of cotton, making it
difficult to swallow or speak.
• Increase cavities due to decreased saliva production
 Myasthenia Gravis
• MG is a neuromuscular disorder that’s usually caused by an autoimmune
problem.
• In this condition, antibodies, which are proteins that normally attack
foreign, harmful substances in the body, attack the neuromuscular
junction. Damage to the neuromuscular membrane reduces the effect of
the neurotransmitter substance acetylcholine, which is a crucial substance
for communication between nerve cells and muscles.
• This results in muscle weakness.
 Myasthenia Gravis
• Myasthenia gravis affects nerve impulses that help the brain control the
muscles.
• When the communication from nerves to muscles is impaired, signals can’t
direct the muscles to contract.
• The most common symptom is muscle weakness that gets worse with activity
and improves with rest.
• Often muscles that control eye movements, eyelid opening, swallowing, and
facial movements are involved.
 Treatment
• Thymus gland removal
• Plasma exchange to remove harmful antibodies
• Intravenous immune globulin (IVIG) is blood product that comes from
donors.
• Although it’s not entirely known how IVIG works, it affects the creation
and function of antibodies.
 Autoimmune Vasculitis
• Autoimmune vasculitis happens when the immune system attacks blood
vessels.
• The inflammation that results narrows the arteries and veins, allowing less
blood to flow through them.
 Pernicious Anemia
• This condition causes deficiency of a protein, made by stomach lining
cells, known as intrinsic factor that is needed in order for the small
intestine to absorb vitamin B-12 from food.
• Without enough of this vitamin, one will develop an anemia, and the
body’s ability for proper DNA synthesis will be altered.
 Celiac Disease
• People with celiac disease can’t eat foods containing gluten, a protein found in wheat,
rye, and other grain products.
• When gluten is in the small intestine, the immune system attacks this part of the
gastrointestinal tract and causes inflammation.
• celiac disease affects about 1 percent of people in the United States.
• A larger number of people have reported gluten sensitivity, which isn’t an autoimmune
disease, but can have similar symptoms like diarrhea and abdominal pain.
• Will be covered in greater detail in GI lecture
 Symptoms
• fatigue
• achy muscles
• swelling and redness
• low-grade fever
• trouble concentrating
• numbness and tingling in the hands and feet
• hair loss
• skin rashes
 Vitamin D
• Fat soluble vitamin obtained from diet as well as synthesized in the body in the presence
of UV light
• Vit D binds to receptor on transcription site and regulate mRNA expression
• All immune cells have Vit D receptors
• Most have the ability of converting Vit D to its active form which helps to regular
inflammation at the local site
• Low sunlight exposure and Vit D def is associated with signs and symptoms of immune
of auto immune diseases and relapse occur more often in periods of low sunlight.
 Vitamin A
• Needed for maintenance of immune system
• Plays a role in differentiation and proliferation of immune cells
• Vit A have been shown to improve rheumatoid disease in animal models
• Source of Vit A
• highest in liver and fish oils. Also in milk and eggs
• Most dietary vit A comes from beta carotene in leafy green vegetables, orange and
yellow vegetables, tomato products, fruits, include carrots, broccoli, cantaloupe, and
squash.
 Anti-inflammatory diet
• High intake of fresh foods, vegetables and fruits, especially berries
• Limit processed foods
• Limit sugar, (sucrose and fructose)
• Lean protein from chicken, fish, legumes and nuts
• Essential fatty acids and fiber
• Mediterranean diet – reduces inflammation (IL-1, IL-6, TNK-alpha)
• Olive oil anti-inflammatory and high in phytochemical
General Principles of Anti-inflammatory Diet
• A variety of fruits and vegetables
• Some may need to avoid night shades –vegetables with alkaloids
• eggplants, peppers, white potatoes, tomatillos, tomatoes
• Low saturated fat and trans fat
• Low omega 6 fats (vegetable oils and animal fats)
• High monounsaturated fats
• Olive oil, walnuts, pumpkin seeds
• High omega 3 fats
• Chia seeds, fatty cold-water fish,
 General Principles of Anti-inflammatory Diet
cont’d
• Low in refined carbohydrates
• Increase whole grains
• Lean protein
• Limit eggs, red meat, butter, and full fat dairy products
• Include anti-inflammatory spices – ginger, curry, turmeric, rosemary
• Include green, white and oolong teas and soy foods
 Gout
• Disorder of purine metabolism with accumulation of uric acid in blood
• Seen more often in men
• Normally, uric acid dissolves in your blood and passes through your
kidneys into your urine. But sometimes either your body produces too
much uric acid or your kidneys excrete too little uric acid. Uric acid
builds up, forming sharp, needlelike urate crystals (tophi)in a joint or
surrounding tissue that cause pain, inflammation and swelling.
 Nutrition intervention for gout
• Plenty of water. Limit sweetened beverages you drink, especially those sweetened with fructose (fructose
increase urate)
• Limit or avoid alcohol. Beer may be particularly likely to increase the risk of gout symptoms, especially in men.
• Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein
sources. Beans and legumes not associated with flare up.
• Limit your intake of meat, fish and poultry. A small amount may be tolerable, but pay close attention to what
types — and how much — seem to cause problems for you.
• Losing weight may decrease uric acid levels in your body however, avoid fasting or rapid weight loss
• Cherry juice lowers uric acid level
• Vit C may also be helpful
 Osteoarthritis
• Osteoarthritis (OA) is a painful and life-altering disease that severely
limits the daily activities of millions of Americans, and it is one of the
most common causes of disability in the world.
• Chronic synovial joint disease, characterized by two main features:
• (1) progressive damage of articular cartilage, bone remodeling, and new bone
formation (osteophytes and subchondral bone sclerosis) and
• (2) synovial inflammation and fibrosis of ligaments, tendons, menisci, and capsules
 Glucosamine and Chondroitin
• Needed for cartilage production
• Helpful in relieving pain in patients with moderate to sever OA
• Did not prevent loss of cartilage in knees
 Avocado/soybean unsaponifiables
• Avocado/soybean unsaponifiables are natural vegetable extracts made
from avocado and soybean oils
• ASU is composed of one third avocado and two thirds soybean
• The major components of ASU are phytosterols β-sitosterol, campesterol,
and stigmasterol, which are rapidly incorporated into cells. ASU is a
complex mixture of many compounds including fat-soluble vitamins,
sterols, triterpene alcohols, and possibly furan fatty acids. The identity of
the active component(s) remains unknown.
Dietary supplement avocado/soybean unsaponifiables (ASU)

• Anticatabolic properties prevent cartilage

• ASU also inhibits fibrinolysis
• Anabolic properties promote cartilage repair by stimulating collagen and aggrecan synthesis via
inhibition of inflammatory cytokines such as interleukin (IL)-1, IL-6, IL-8, tumor necrosis factor,
ERK, and prostaglandin E2.
• Chondroprotective effects are mediated by correcting growth factor abnormalitie
• ASU also inhibits cholesterol absorption and endogenous cholesterol biosynthesis, which mediate
reactive oxygen species pathology in chondrocytes.
• At the clinical level, ASU reduces pain and stiffness while improving joint function, resulting in
decreased dependence on analgesics.
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303902/
• Management of Osteoarthritis with Avocado/Soybean Unsaponifiables
• Blaine A. Christiansen, Simrit Bhatti, Ramin Goudarzi, and Shahin
Emami
• Cartilage. 2015 Jan; 6(1): 30–44.