Diet + Autoimmune Disease: Let's Ask An Expert

As a dietitian who specializes women's health, I often encounter women who have autoimmune diseases. These diseases - like Celiac, Hashimoto's, and Inflammatory Bowel Disease - are far more likely to affect women than men.

I knew the link between diet and autoimmune disease matters, but have been wanting to learn more details. Are there foods to avoid? What strategies promote being healthy with autoimmune conditions?

A Dietitian Who Specializes in Diet + Autoimmune Diseases

I have recently had the honor of meeting fellow Nashville dietitian Lindsay Peter-Contesse, MS, RDN, LD, IFNCP, owner of Nashville Autoimmune Nutrition. As her business name suggests, Lindsay is the expert on all things autoimmune. She holistically helps people enhance their quality of life through diet and lifestyle changes. She can relate, too - Lindsay has personal experience living with autoimmune disease.

I picked Lindsay's brain on what women need to know about diet + autoimmune diseases!

Lindsay Peter-Contesse is a Nashville dietitian who works with individuals with autoimmune diseases.

Q & A with Lindsay Peter-Contesse, RD for Autoimmune Diseases

I've heard that a vast majority of people with AI diseases are women! Why is this?

Yes, 78% of those with autoimmune diseases are women! There are no definite answers as to why, just theories at this point. One theory is that hormones play a role in making women more susceptible to AI disease. However, this is just a theory and not yet confirmed. 

I got ahead of myself - in a nutshell, what are AI diseases?

Autoimmune disease occurs when the immune system mistakenly attacks its own tissues and/or organs.

A normal immune system creates antibodies when a foreign substances comes into the body to help fight and clear the substance out (this is a good thing). In autoimmune diseases, the body mistakenly creates autoantibodies. These autoantibodies trigger the immune system to stimulate an attack against itself. When enough damage occurs, autoimmunity develops.

Autoimmune disease can occur in the thyroid, bones, muscles, skin, lungs, nerve, GI tract, blood and brain. There are 140 different autoimmune diseases and related disorders. 

Why does an autoimmune attack happen?

3 things need to happen for autoimmune disease to occur:

1. Genetic predisposition
2. A environmental triggers/stressor (ex: infection, pregnancy, trauma/stress-physical or emotional)
3. Diet and lifestyle

When these three combine, it is the perfect storm to develop autoimmunity. 

I will use myself as an example here. When I started having autoimmune symptoms, I was in a high stress job (lifestyle), had experienced trauma (environmental trigger), my (diet) was filled with inflammatory triggers and I had the (genes) for celiac disease. When these all combined, I developed full-blown AI disease. 

Unfortunately, we do not have control over our genes or environmental triggers but we do have some control in diet and lifestyle. And these can have profound impacts on prevention, healing and symptom management. 

What are typical autoimmune disease symptoms?

Autoimmune diseases operate in the same manner, no matter the type of disease—the body attacks its own tissues/organs. The difference is simply which organ/tissue it attacks. There are over 200 possible symptoms and vary person to person but here are some of the more common symptoms among AI diseases. 

• Fatigue
• Joint and muscle pain
• Headaches
• Migraines
• Depression
• Anxiety
• Allergies
• Skin issues, rashes, acne
• GI Issues: constipation, diarrhea, heartburn, frequent gas/belching, pain.
• Blood pressure changes: usually low, but can be high
• Low blood sugar 
• Low grade or recurring fever
• Malaise (generally feeling unwell for unexplained reason)
• Thyroid problems
• Unexplained weight changes, gain or loss
• Susceptibility to infections
• Brain fog
• Memory problems and difficulty concentrating 
• Sleep disturbances
• Muscle weakness
• Swollen glands
• Yeast infections
• PMS

Wow - that's a long list. So, which AI diseases who you most commonly see among women?

I see a variety, but here are some of the autoimmune conditions I see more often:

• Hashimoto’s thyroiditis
  • fatigue, hair loss, anxiety, brain fog, food sensitivities.
• Sjogren’s syndrome
  • dry eyes and mouth, fatigue, anxiety, other unexplained symptoms.
• Celiac disease
  • GI related issues like diarrhea or constipation (but not always), nutrient deficiencies, fatigue, anxiety, allergies/sensitivities. 
• Rheumatoid Arthritis
  • joint pain, fatigue, anxiety
• Inflammatory Bowel Disease, or IBD (Crohn’s disease and Ulcerative Colitis)
  • abdominal pain, diarrhea/constipation, blood in stool, fatigue, allergies/sensitivities

What do you wish more people knew about AI diseases in general?

A few things:

1. 45% of people were labeled as hypochondriacs (“your symptoms are all in your head”) in the early stages of their disease. Keep trusting your gut when something is off. Be your own advocate and find the care you need.
2.  Many of those with AI diseases do not look sick. And just because you cannot see it does not mean it is not there. So if you are reading this and have autoimmune disease/diseases, I see you! And what you are experiencing is real. 
3. These are chronic diseases and have no cure. 
4. There is hope in managing, reducing symptoms, and having a greater quality of life. Nutrition and lifestyle has a profound impact on health.

Keep trusting your gut when something is off. Be your own advocate and find the care you need.

- Lindsay Peter-Contesse, Registered Dietitian specializing in Autoimmune Diseases

What are some essential strategies women should know about nutrition when you have an AI?

• Avoid trigger foods. This will vary person to person so you will want to work with a nutrition practitioner to see which are your specific triggers. But one common food trigger is gluten. This is hard because gluten free is still a fad diet for many, but for those with autoimmunity, removing this can be crucial for healing. So what happens with gluten? In your small intestine lining you have tight junctions. These tight junctions help keep food in the stomach and out of the blood stream. Gluten is really good at opening these tight junctions and crossing into the blood stream. The term used when this occurs is intestinal permeability (things are getting into the blood that should not).  When gluten gets into the bloodstream, it can wreak havoc on the body. Gluten can even cross the blood brain barrier which is why it’s common for those with AI to have anxiety or depression. 

• Increase the nutrient dense foods. The more nutrient dense foods you have, the faster the healing process can occur. Besides organ meat (which not many of us are eating), vegetables are the most nutrient dense foods available. Vegetables are rich in antioxidants, vitamins, minerals, phytochemicals, and fiber. The more color and variety the better! Aim for ½ your plate to be veggies.

• Check your lifestyle. This actually has a greater impact on your healing that nutrition. You can be eating all the “right” things but if you have an extremely stressful lifestyle, your healing will only go so far. In my practice we discuss mind/body exercises, self-care, sleep, stress management, etc. 

Avoiding trigger foods and increasing nutrient-dense foods are both part of how diet and autoimmune disease connect.

What's a common misconception about AI and nutrition you often hear?

That nutrition does not play a role in healing autoimmunity. This does not make sense and research says differently. Food can positively (or negatively) impact the AI disease process.

Here is just one study on how nutrition improved disease state of those with Crohn’s and Ulcerative Colitis.

How do autoimmune diseases affect fertility and pregnancy? And vice versa?

Having autoimmune disease can make it more difficult to conceive. In fact, unexplained infertility can be a symptom of autoimmune disease.

There are AI diseases that are more strongly linked to infertility: autoimmune thyroiditis, systemic lupus erythematosus, diabetes, endometriosis, Sjogren’s syndrome, Raynaud’s syndrome (1). It is still possible to conceive! It is helpful to manage your disease as effectively as possible while trying to conceive.

Unfortunately, miscarriages are  also more common among those with autoimmune disease (2).

Pregnancy/postpartum can be different for each women. These are not the only scenarios but here are some that have been researched and I have seen in my practice.

1. The autoimmune disease symptoms flares during pregnancy and the woman does not feel well.
2. The autoimmune disease symptoms is suppressed during pregnancy and the woman feels great.
3. The autoimmune disease that flares during pregnancy goes away after birth.
4. Autoimmune disease flares after giving birth.

Every pregnancy is different. To use myself as an example again, I felt wonderful during pregnancy. In fact, I had not felt that good in years. But then 4 months after birth I experienced an intense flare. This flare was likely due to hormonal changes, stress, and lack of sleep. SO much lack of sleep. Ha.

Knowing that a flare-up could occur during or after pregnancy may make it smart for someone planning to get pregnant or for those who recently became pregnant to proactively seek help to minimize triggers during and after pregnancy. Grace and I can collaborate care with clients so if you are interested on working on fertility and managing your chronic illness, please reach out to Grace! 

Do AI diseases have any other effects on women's health? Puberty, periods, menopause...? 

Yes, the hormones changes during puberty, pregnancy, and menopause impact the immune system. I reference a study below if you would like to read more but in short, these hormonal transitions impact both the innate and adaptive immune system. There are certain autoimmune diseases that are more linked to these endocrine changes (3). These include multiple sclerosis, systemic lupus erythematosus, type 1 diabetes, rheumatoid arthritis, and psoriasis.

When do you need to work with a dietitian if you have an autoimmune disease?

This will depend on how well your AI disease is managed. People often come to see me when they have symptoms that are unmanageable and are ruling their life. There is also something to be said about prevention. If you are exhibiting some signs of AI disease but have not be diagnosed with AI, this could be a good time to reach out. 

As a dietitian who specializes in autoimmune diseases, what does your work with people "look like"? And how do we find you?!

Autoimmune diseases are complex and present differently for each person. From sorting through recommendations of food choices, supplements, to even being told there is no solution or “it’s all in your head.” It can be completely overwhelming.

I take a functional and integrative approach with clients by looking for the root cause of symptoms, and addressing all aspects of the client’s lifestyle. I begin with a comprehensive assessment, exploring factors such as medical history, lifestyle patterns, and current symptoms. Gathering a whole picture from history to current allows us to work together to optimize your journey to health. Each client is different.

Some common goals include: symptom relief, healing, and regaining a better quality of life. In working together and setting these goals, we ensure they are realistic, achievable, and will work within your lifestyle. 

Managing chronic illness can be exhausting, confusing and lonely. And the journey to healing is not always a straight line. I provide ongoing support to make adjustments in your journey to healing. Our follow up appointments allow for discussing progress, adjusting nutritional & lifestyle plans, and creating manageable next steps. 

If anything above resonates with you, I would love to work with you!

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Thanks to Lindsay Peter-Contesse of Nashville Autoimmune Nutrition for sharing her wisdom! As you can likely tell, Lindsay is super knowledgable on this topic, plus has profound empathy for her clients. Lindsay sees clients virtually right now due to COVID. Reach out to see if she can help you!