Medical Nutrition Therapy For Autoimmune Diseases

Introduction

Medical Nutrition Therapy (MNT) is a pivotal approach to managing autoimmune diseases, offering tailored nutritional interventions to mitigate symptoms and enhance overall well-being. In this article, we will uncover the essential components of MNT, its role in autoimmune disorders, and specific dietary recommendations for conditions like rheumatoid arthritis, lupus, and celiac disease.

An overview of autoimmune diseases 

A brief explanation of autoimmune disorders

 Autoimmune diseases result from the immune system attacking the body's own tissues. This misguided immune response can affect multiple organs and systems, leading to a range of symptoms and complications.

Common autoimmune diseases (e.g., rheumatoid arthritis, lupus, and celiac disease)

 Rheumatoid arthritis, lupus, and celiac disease are among the prevalent autoimmune disorders. Understanding the distinct characteristics of each condition is crucial for tailoring effective MNT strategies.

Role of nutrition in autoimmune diseases

Impact of diet on the immune system

Diet plays a pivotal role in modulating the immune system. Certain foods can either exacerbate inflammation or promote an anti-inflammatory environment, influencing the course of autoimmune diseases.

Connection between gut health and autoimmunity

The gut microbiome has emerged as a key player in autoimmune disorders. MNT focuses on fostering a healthy gut environment to regulate immune responses and reduce inflammation. For instance, the presence of the intestinal bacteria Prevotella copri is strongly associated with the onset of rheumatoid arthritis.^18,19

Principles of medical nutrition therapy for autoimmune diseases

Individualised nutrition plans

MNT recognises the unique nutritional requirements of each individual, considering factors such as age, gender, disease severity, and comorbidities. Personalised nutrition plans are crafted to address specific needs and challenges. When combined with the treatments and medications and changes in diet recommended by your provider (preferably a rheumatologist or an RDN), if they cannot cure you, they most certainly can help reduce inflammation, severity, and the incidence of symptoms specific to your autoimmune disease or condition. Dietary changes are safer and most successful when monitored by your provider.

Nutrient-dense diet recommendations

Emphasising nutrient-dense foods ensures that individuals receive essential vitamins, minerals, and antioxidants crucial for supporting immune function, individualised nutrient deficiencies, and overall health.

Specific dietary recommendations

Anti-inflammatory diet

Emphasis on omega-3 fatty acids

Omega-3 fatty acids found in fatty fish, flaxseeds, and walnuts have anti-inflammatory properties, helping to mitigate inflammation associated with autoimmune diseases. 

Foods rich in antioxidants

Colourful fruits and vegetables, rich in antioxidants like vitamin C and beta-carotene, can neutralise free radicals and reduce oxidative stress.

Gluten-free diet (for diseases like celiac)

For individuals with celiac disease, strict adherence to a gluten-free diet is paramount to preventing autoimmune reactions triggered by gluten consumption.

Importance of vitamins and minerals (e.g., vitamin D, selenium)

Ensuring adequate intake of essential nutrients like vitamin D and selenium is crucial, as deficiencies may exacerbate autoimmune symptoms.¹⁷

Considerations for disease-specific management

Rheumatoid arthritis

Rheumatoid arthritis is a chronic inflammatory disorder that primarily affects the joints, causing pain, stiffness, and swelling.

Nutrition and dietary considerations

Omega-3 Supplementation

Research suggests that omega-3 supplementation may help reduce joint pain and stiffness in rheumatoid arthritis patients.¹¹

Potential benefits of a vegan plant-based  diet (e.g. fruits and vegetables)

Consuming a variety of fruits and vegetables may provide anti-inflammatory compounds that support joint health and improve the gut microbiota.¹²

NOTE: In addition, you can talk to your provider about adding good fats and minimising bad fats, salt, and processed carbohydrates. People with rheumatoid arthritis also have a higher risk of coronary artery disease, which might require specific dietary recommendations to curb high blood cholesterol (a risk factor for coronary artery disease).¹⁴

Lupus

Systemic autoimmune disease can affect multiple organs, leading to symptoms such as fatigue, joint pain, skin rashes, and organ damage. 

Role of anti-inflammatory foods

Incorporating anti-inflammatory foods, such as fatty fish and leafy greens, may help manage inflammation in lupus.

Limiting trigger foods

Identifying and avoiding trigger foods can be crucial in preventing Lupus flare-ups.

You may need dietary supplementation for anaemia or salt restrictions and dietary modifications to manage high blood pressure (hypertension) if lupus causes those issues.

According to a recent study, the Mediterranean diet may be suggested as the preferred dietary pattern in SLE, and nutritional counselling should be part of the multidisciplinary approach in patients with SLE to prevent obesity, malnutrition, and the use of foods that may fuel an inflammatory status and CV risk.¹⁴

Celiac disease (celiac sprue)¹³

Gluten-free diet importance

Strict adherence to a gluten-free diet is of utmost importance when it comes to managing celiac disease and preventing autoimmune responses triggered by gluten ingestion.¹³

Your symptoms begin to improve almost immediately after starting a gluten-free diet.

Conversely, this also means that you might end up triggering your condition if you do not strictly adhere to your diet regimen until your doctor advises you otherwise.

NOTE: You may lose your ability to digest nutrients that you could previously digest because your intestinal mucosa is continuously weakened if your condition remains untreated for too long. You are at high risk of developing lactose intolerance, and other common food intolerances will follow; therefore, strict adherence to a gluten-free diet is of utmost importance here.

Nutrient absorption strategies

Malnutrition can affect your brain and bones, and some of these effects are hard to reverse, especially when they occur during the development years of a child.

Supporting nutrient absorption through dietary strategies is therefore essential, especially for individuals with compromised nutrient absorption. 

NOTE: It may take several weeks to replace your nutritional deficiencies and several months for your gut to fully heal.

Monitoring and assessment

Regular nutritional assessment

According to Dr. Anna Hernandez, assessment usually includes taking a record of the following parameters:

• Health conditions( for instance: celiac disease, rheumatoid arthritis, lupus,s etc)}
• Body measurements [such as height and weight, body mass index (BMI), skin fold thickness, and arm or leg circumference]
• Nutrition status [using Blood tests to determine the individual’s nutritional status, such as glucose, glycated haemoglobin (HbA1c), cholesterol and triglyceride levels, prealbumin, vitamins, and micronutrients (e.g., sodium, potassium, calcium, phosphate, etc.]
• Estimation of daily total calorie intake (includes: Eating habits, portion sizes and cooking methods) 
• Other factors affecting dietary intake include changes in smell and taste preferences.
• Use of dentures for swallowing difficulties or aspiration risk
• Food intolerances 

Regular assessments, including dietary intake analysis and monitoring of symptoms, are integral to evaluating the effectiveness of MNT and making necessary adjustments.

Collaboration with healthcare professionals

Medical nutrition therapy is usually recommended by a healthcare provider and thoroughly assessed by a Registered Dietitian-Nutritionist (RDN) who works closely with the individual and medical team to establish an individualised nutrition plan, Dr. Anna says.

Challenges and considerations

Patient adherence

Improving patient adherence is crucial for successful medical nutrition therapy (MNT). 

• Creating awareness and educating patients, family members, and healthcare providers about the significance of nutrition in managing autoimmune diseases can enhance compliance. 
• Strengthening the implementation of effective nutrition programmes at the primary level of care is essential. 
• Dietitians should devise nutritional plans considering cultural needs, economic status, and available support to achieve sustainable results.
• Medical nutrition therapy and malnutrition should become a topic in the education and training of medical staff because the causes of malnutrition are often multifactorial (from depression and lack of appetite to inability to self-feed), Communication and collaboration should be improved between the different members of the multidisciplinary team and between the team and the patient.
•  Additionally, behavioural counselling with regular reinforcement is important.

Potential interactions with medicines

Considering potential interactions between certain foods and medications is vital to preventing adverse effects and optimising treatment outcomes. Let's understand these with certain illustrations.

Interaction between omega-3 fatty acids and anticoagulants

Omega-3 fatty acids, commonly recommended in autoimmune diseases for their anti-inflammatory properties, may interact with anticoagulant medications, increasing your risk of bleeding. Monitoring coagulation parameters is advisable for such patients. (Bays, 2007)⁶

Impact of high-fibre diets on medication absorption:

High-fibre diets, often recommended in medical nutrition therapy, can potentially bind to certain medications, reducing their absorption and efficacy. Administering medications at least two hours apart from high-fibre meals is suggested to minimise interactions (Dresser et al., 2005).⁹

Vitamin K content in green leafy vegetables and warfarin

Patients on warfarin, an anticoagulant, need to maintain a consistent intake of vitamin K. Green leafy vegetables, rich in vitamin K, may interfere with the anticoagulant effect. Close monitoring and consistent vitamin K intake are essential to prevent fluctuations in anticoagulation status 

Grapefruit juice and drug metabolism

Grapefruit juice can inhibit the activity of cytochrome P450 enzymes in the liver, affecting the metabolism of various medicines, and leading to increased drug concentrations in the body and potential adverse effects. Patients should be advised to avoid grapefruit juice with medications that undergo hepatic metabolism.^9,10,15,16

Benefits of MNT in symptom improvement and quality of life enhancement," including real-life examples

Although there is no specific diet for the treatment of autoimmune diseases, there are nutrients known to influence the functioning of the immune system. An anti-inflammatory diet limited to pro-inflammatory compounds can be used to control autoimmunity. Nutrients can prevent inflammation through restriction of the production of pro-inflammatory cytokines, including IFN-γ, and through promotion of regulatory T-cell function.⁷

Research indicates that an individual's nutritional status and metabolic health, including obesity and metabolic syndrome, can affect autoimmune disease risk and management. Dietary patterns, macronutrient and micronutrient intake, and non-nutrient factors like gut microbiome profiles also play a role. Hence, nutritional interventions may be effective in reducing risk and managing autoimmune disorders.⁸

Recent studies have shown that dietary interventions, such as the consumption of omega-3 fatty acids and anti-inflammatory foods, can help reduce inflammation and improve symptoms of autoimmune diseases like rheumatoid arthritis and lupus. For example, a study published in the Journal of Rheumatology found that omega-3 supplementation reduced joint pain and stiffness in rheumatoid arthritis patients. Another study published in the American Journal of Clinical Nutrition found that a Mediterranean diet, rich in fruits and vegetables, was associated with improved outcomes in systemic lupus erythematosus.

When should you see a healthcare provider?

Visit a healthcare provider as soon as you notice any new or changing symptoms. Even small shifts in what you’re eating can be important.

Talk to your provider if it feels like your dietary modifications aren’t managing your symptoms as well or as they used to.  Tell your provider if you’re having flare-ups more often. They’ll help you adjust your diet as needed.

Summary

 The article emphasises the pivotal role of Medical Nutrition Therapy (MNT) in managing autoimmune diseases by tailoring nutritional interventions to alleviate symptoms and enhance overall well-being. The key points highlighted include the personalised nature of MNT, the impact of diet on the immune system, and specific dietary recommendations for prevalent autoimmune disorders.

Furthermore, the article stresses the importance of individualised nutrition plans, nutrient-dense diet recommendations, and disease-specific management considerations. It also discusses the connection between gut health and autoimmunity and the significance of monitoring and collaboration with healthcare professionals in ensuring effective MNT.

In looking towards the future, the article suggests that continuous improvement in MNT approaches for autoimmune disorders can be achieved by addressing ongoing research and exploring areas that require further investigation. By highlighting these future directions and research needs, the article encourages a proactive approach to refining MNT strategies and ultimately improving patient outcomes in the realm of autoimmune diseases.