WHY YOU?

After accepting that I was very ill with a complicated disorder, some of the first questions I asked myself were, "why me?" and "what now?" After experiencing this journey and uncovering some insights, I hope I can provide you with some structure for understanding and a perspective that helps you make better decisions about your health. Today, we know that there are over 100 diseases related to autoimmunity. Our immune system makes an error and attacks our own body. These assaults can occur on any organ, muscle, or system. What causes this? And why did autoimmunity target you?

Dr. Alessio Fasano, a world-renowned gastroenterologist and expert, says that in order for autoimmunity to occur, there must be 3 contributing factors:

1. Genes: a predisposition to some autoimmunity

2. Environment: a trigger that activates your immune system

3. Weakened intestinal permeability: a weakened interplay between genes and environment; sometimes referred to as "leaky gut"

Since all three factors have to be present for autoimmunity to develop; then theoretically if one or more of these factors can be eliminated, we may halt autoimmunity; and in the long term bring it to remission. Let's look at these 3 factors, one at a time to consider our best strategies for healing.

Genes

Are we hard-wired with an autoimmune vulnerability? The answer is yes. Our genes can indicate if we have a vulnerability to autoimmunity, as well as what system or organ is most vulnerable. Keep in mind this does not mean that those genes will ever express this autoimmunity in our lifetime. Genes do NOT solely determine your fate in life. Can we change our genes? No, at this time we cannot change our genetic vulnerabilities. If you are curious as to what genetic vulnerabilities you may have, there are tests that can bring you these answers. Cyrex Labs™ has a test, Multiple Autoimmune Reactivity Array 5, which can identify multiple autoimmune antibodies. Work with your medical provider and this lab to get this information. But remember, genetics are NOT 100% our destiny. In order to arrest the autoimmunity, we must focus on the controllable factors — he environment and intestinal function.

Environment

Are there triggers in our environment that make us more vulnerable to autoimmunity? Yes, absolutely. Food can often be a triggering component because eating is one of the main interactions between our internal bodies and our external environment. Our digestive system is the playground where these interactions play out. This is why experts are now saying that a majority of our immune system is affected by our digestive function. In this book, we focus on dietary triggers; however there can be non-dietary triggers, like chemical exposure (breathing in or touching) from a pesticide or a heavy metal that activates your immune system.

Recall that an immune system only mounts a response if there is a threat. If a threat does not exist, no immune response occurs. This means that we increase our vulnerability with exposure to certain threats, or triggers. It also means that if we can remove the threat, theoretically we can halt the autoimmune responses. Over time, we can arrest the development of further autoimmunity and begin the healing process.

A main strategy to deal with environmental triggers is to identify potential threats, and eliminate exposure to them. What if you don't know what your triggers could be? Then you can try to identify them through a basic elimination diet and monitoring your progress. A diet that is free of gluten, dairy, and refined sugar is recommended as a starting point. This guide explains this diet in more detail later; but the idea is to start somewhere. Whether it is a diet free of gluten only, or dairy only, or both gluten and dairy; the point is you must start somewhere and follow through. The cookbook section includes tasty recipes for you to get started immediately by adding clean foods into your daily diet.

Weakened Intestinal Permeability

According to Dr. Fasano our gut functions beyond digestion and absorption; it also regulates traffic (at a macromolecule level) between the external environment and the internal body through its barrier mechanism. When this traffic doesn't get to the right destination, the intestinal function becomes faulty.

When macromolecules enter the bloodstream before the right time, this is sometimes referred to as "leaky gut." Why does intestinal permeability weaken? Some studies suggest that certain foods, namely gluten, could be encouraging this. But even if one has leaky gut, if you don't have a genetic predisposition or other environmental trigger, you will not develop autoimmunity. This helps to explain why someone who shares your meals and environment may not get sick, when you do. It also helps to understand that autoimmunity requires a perfect storm of 3 simultaneous factors.

Known Autoimmune Disorders

Currently, there are over 100 known autoimmune or autoimmune-related disorders on a list maintained by the American Autoimmune Related Diseases Association, Inc (AARDA). They add more diseases to this list as more evidence connects autoimmunity to an illness. Current known autoimmune disorders are listed in the appendix along with links for more information on each flavor of autoimmunity, but there are always more being investigated. For more complete and current information, consult the AARDA.

WHAT NOW?

Understanding the triad of factors that led to this perfect storm of autoimmunity may help you come to terms with why you are in the position you are. Basically you are in a boat trying to sail over this perfect storm of raging waters; but it doesn't help you understand what actions to take or what your resources are – where is your life jacket? What is your safest path? Is it possible to calm the raging waters around you? Because autoimmunity is a relatively new subject of research, and many trials are still underway, we are learning more each day about environmental triggers and gut healing supplements. The statistics of people with autoimmunity is ever-increasing, so the world may soon be overwhelmed with news about autoimmunity, chronic inflammation, and super foods for managing this disorder; but for now the main take-away message remains that autoimmunity IS recoverable.

Is it quick and easy? No and no. It may have taken you decades to get to the predicament you are now in; so it may take several months of work to begin seeing progress. It may take several years to find remission. But don't lose hope because you can do it. Autoimmunity occurs when we experience a triad of factors, but only 2 of those factors are controllable: weakened intestinal permeability and environmental triggers. In this chapter, we explore these two controllable factors for a better understanding of what new changes can support us.

Intestinal Permeability

The most controllable path to improved immune health is to recover weakened intestinal permeability. Our food is the product of our environment. Intestinal permeability is the mechanism where the external environment interacts with the internal body. In normal intestinal permeability, food passes through your intestines, tubes that are permeable. The particles that are small enough to pass through the barrier mechanism of the intestinal walls can PASS, while the larger molecules don't pass until they are broken down into smaller particles by your digestive system. Once the small particles pass or permeate the barrier, they enter the bloodstream and are directed accordingly. But what if the barrier mechanism is weak or dysfunctional? What if it allowed larger molecules to enter the bloodstream? If the body was not expecting a larger molecule and didn't have a plan for it, our immune system would be called into action. Our immune system would activate and build up a defense mechanism to eliminate the "foreign" unrecognized invader. If there were many invaders, our immune system would activate more defenses until the job was done.

Molecular Mimicry

The way the immune system works is a fact. In autoimmunity, the immune system attacks itself – that is a fact also. But why does our body attack itself? There is a theory called molecular mimicry to explain this. In all this chaos, it is believed that sometimes a case of mistaken identity can take over the process where the immune system is actually attacking its own body's cell or tissue instead of a foreign invader. For example, gluten is notorious for being leaked into the bloodstream before being broken down. The structure of this gluten protein molecule can possibly seem very similar to other protein molecules that can reside on the surface tissue of an organ. If a gluten molecule was leaked into the bloodstream too early, our body wouldn't recognize it and activate the immune system to get rid of the "foreign invader." Our immune system would program itself to rid the body of that molecule, but instead it could mistakenly assault a similarly assembled peptide molecule (on surface tissue of an organ) and unintentionally create damage to a particular organ (for example the thyroid in the case of Graves' Disease or Hashimoto's). This theory is called molecular mimicry. The medical professionals I speak to consider this theory very plausible. It explains so much.

The strategy to strengthen the intestinal barrier involves dietary changes. These changes help to enforce the tight junctions of the intestinal barrier and decrease chronic inflammation. While genetics may increase the risk of leaky gut, a modified elimination diet might decrease the complications and eventually (over a long period of time) heal the condition.

A Modified Elimination Diet

The idea behind an elimination diet is to eliminate health threats from our diet. But we may not know what those threats could be, so where do we start? A good place to start is to eliminate some common trigger foods, and see how you progress over several weeks. If you do well, then you may have eliminated your trigger; if not, then you try another elimination diet. It may be a process of trial/error; but eventually you may find and eliminate the trigger.

For example you may start with a gluten elimination diet. A successful transition does not begin until you learn and love at least 10 dishes that work with your elimination diet. So gradually introduce yourself to gluten free dishes until you learn and love at least 10 different gluten free meals. During this time you have not changed your diet in any permanent way –no deprivation, only addition. This is critical to success. Once you have at least 10 go-to meals that can work with your desired elimination diet, then you can decide when to officially commit to the elimination diet for at least 6 weeks. Keep a journal during the elimination diet to best determine your reactions, symptoms, and emotions. This may give insight with gradual improvements.

If improvements are seen, it may be a successful elimination diet for you; if not, try another elimination diet by first going back to your normal diet for several weeks and journaling reactions, symptoms, and emotions. Then start again by introducing foods of your next elimination diet until you have at least 10 new foods. As you can see this can be a lengthy process; but when you find your triggers, it is completely worth it. So be patient and embrace the process.

Continue a successful elimination diet over several months to allow your weakened intestinal barrier to heal. Timeframes are subjective, but after stabilization (perhaps 6 months or so) you can start the reintroduction process ONE FOOD AT A TIME. What this means is that you will need to know how to eat nutritionally balanced meals on your elimination diet for several months. This is where the cookbook might come in handy! If this sounds like an overwhelming process to go through alone, I recommend you commit several weeks preparing your kitchen and pantry for success with the new diet and looking at your daily meals and mentally envision changes. For example, you might notice that today you are eating a sandwich and chips for lunch. Think to yourself, next week I will have a soup and salad for lunch followed by a mid-afternoon smoothie. Envision the success you will experience with less symptoms (brain fog, fatigue, bloating, diarrhea, constipation) and invest the time for your health. If you still feel overwhelmed, consider hiring a health coach to support you during this process with guided tips and strategies for success and continual monitoring.

The cookbook section focuses on a diet free of gluten, dairy, and refined sugar; and all the recipes are vegetarian. Most of the recipes feature centuries-old Asian ingredients, preparations, and fermentation techniques used for health and recovery. Today increased access of Asian vegetables and ingredients in markets have increased awareness and popularity of these healing foods. Many digestive spices used are listed in the appendix along with their digestion related benefit as a reference. Reasons for this particular elimination diet as a starting point follow, but you should consult your doctor before any elimination diet begins. Also inquire about any testing which should be done for celiac disease or other disorder BEFORE altering your diet.

Gluten free

The toxic component people refer to as "gluten" is a protein specifically found in wheat, rye, and barley. Why is it considered toxic? Dr. Fasano states that, "no human can digest gluten." What this means is that no human being has all the necessary enzymes to COMPLETELY digest gluten. Not all of us will see bad consequences of this indigestion, but some of us do. If current statistics are correct, there are a growing number of people that are seeing negative consequences (gastric and otherwise). People with gastric symptoms are becoming more aware of gluten sensitivity or intolerance. There are a growing number of people diagnosed with autoimmune disorders triggered by gluten — eliac disease, non-celiac gluten sensitivity (NCGS), and others. Among those that have a genetic predisposition to a gluten-related autoimmunity, avoiding gluten is the number 1 method of bringing normalcy back for each of the disorders on this list. It is not a fad, but a permanent path for a healthy life.

Dairy Free

One dietary change that seems to show a reversal of autoimmune disease is by removing BOTH gluten and dairy simultaneously. But why is dairy being eliminated? One theory for this is a type of mistaken identity like molecular mimicry. We have already discussed where this mistaken identity contributes to our own cells and tissues being attacked. A current theory on why dairy must also be simultaneously removed with gluten is that the protein molecules of dairy and gluten are very similar. This similarity is increasing the risk of more mistaken identity where the dairy foods cause an immune reaction (with an activated immune system). However by removing both the gluten and the dairy, the body has a chance to calm down and begin the healing process. At a later point, dairy can be reintroduced to see if it can be tolerated without further issue. If an allergy or intolerance is present for lactose or casein or any other dairy component, then dairy may continue to pose a problem and should be avoided.

Refined Sugar Free

Americans consume 130-145 pounds of refined sugar annually. Aside from providing some immediate energy, it holds no nutrient value. Other foods can yield energy AND provide nutrient value, so refined sugars are not valuable for our body, and they are an inflammatory food. In the healing phase of autoimmunity, we must strive to remove chronic inflammation. As if these aren't enough reasons, newer studies are correlating increased sugar intake and the presence of leaky gut citing that the sugars may be supporting unhealthy bacteria in the gut. This concludes that while our mind craves refined sugar, our body needs to avoid it. The cookbook recipes may offer some resource on what you could eat if you gave up refined sugar for a period of time. Non-processed sugars that are natural are not "refined sugars" so they are included. Our taste buds are in love with sweet tastes, but there are actually 4 other tastes that our tongues can differentiate (salty, sour, bitter, and umami). Eastern science indicates that we should strive for a balance of ALL those tastes. Can this be learned? Of course it can. We learn from infancy what foods make us feel comfortable. We can strive to crowd our diet with foods that use more natural sugars rather than refined when we want a sweeter taste. We can also learn to indulge in foods of different tastes, and over time we get accustomed to this.