Medical Compass: Regulating the immune system with diet
Dietary changes can reduce inflammatory factors
By David Dunaief, M.D.
The common thread for more than 80 different autoimmune diseases is that the body’s immune system is attacking organs, tissues and cells and causing chronic inflammation (1). Type 1 diabetes, lupus, rheumatoid arthritis (RA), psoriasis, psoriatic arthritis, multiple sclerosis, Crohn’s disease, and inflammatory bowel disease are among the list of frequently occurring ones. Unfortunately, autoimmune diseases tend to cluster (2). This means that once you have one, you are at high risk for developing others.
Immunosuppressive therapies
Immunosuppressive therapies are the most prevalent treatment for autoimmune issues. As the name suggests, these reduce underlying inflammation by suppressing the immune system and interfering with inflammatory factors.
There are several concerning factors with these treatments.
First, they have substantial side effect profiles. They increase the risks for cancers, opportunistic infections and even death (3). Opportunistic infections can include diseases like tuberculosis and invasive fungal infections.
It makes sense that suppressing the immune system would increase the likelihood of infections. It’s also not surprising that cancer rates would increase, since the immune system helps fend off malignancies. One study showed that after 10 years of therapy, the risk of cancer increased by approximately fourfold with the use of immunosuppressives (4).
Second, these drugs were tested and approved using short-term clinical trials; however, many patients are prescribed these therapies for 20 or more years.
What other possibilities are there to treat autoimmune diseases? Studies are underway that test the efficacy of medical nutrition therapy using bioactive compounds and supplementation. Medical nutrition therapy may have immunomodulatory (immune system regulation) effects on inflammatory factors and on gene expression.
Medical nutrition
Raising the level of beta-cryptoxanthin, a carotenoid bioactive food component, by a modest amount has a substantial impact in preventing RA. Several studies have also tested dietary interventions in RA treatment (5). Included were fasting followed by a vegetarian diet; a vegan diet; and a Mediterranean diet, among others. All mentioned here showed decreases in inflammatory markers, including c-reactive protein (CRP), and improvements in joint pain and other quality of life issues.
What are the effects of fish oil?
Fish oil may help your immune system by reducing inflammation and improving your blood chemistry, affecting as many as 1,040 genes (6). In a randomized clinical study, 1.8 grams of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) supplementation had anti-inflammatory effects, suppressing cell signals and transcription factors (proteins involved with gene expression) that are pro-inflammatory.
In RA patients, fish oil helps suppress cartilage degradative enzymes, while also having an anti-inflammatory effect (7). A typical recommendation is to consume about 2 grams of EPA plus DHA to help regulate the immune system. Don’t take these high doses of fish oil without consulting your doctor, because fish oil can have blood-thinning effects.
Do probiotics help?
Approximately 70 percent of your immune system lives in your gut. Probiotics have immune-modulating effects that decrease inflammation by populating the gut with live beneficial microorganisms. Lactobacillus salvirus and Bifidobacterium longum infantis are two strains that have been shown to have positive effects (8, 9).
In a study with Crohn’s disease patients, L. casei and L. bulgaricus reduced the inflammatory factor TNF-alpha (10). To provide balance, I recommend probiotics with Lactobacillus to my patients, especially with autoimmune diseases that affect the intestines, like Crohn’s and ulcerative colitis.
Does increasing fiber help?
Fiber has been shown to modulate inflammation by reducing biomarkers, such as CRP. In two separate clinical trials, fiber either reduced or prevented high CRP in patients. In one randomized controlled trial, 30 grams, or about one ounce, of fiber daily from either dietary sources or supplements reduced CRP significantly compared to placebo (11).
In the second trial, which was observational, participants who consumed the highest amount of dietary fiber (greater than 19.5 grams) had reductions in a vast number of inflammatory factors, including CRP, interleukin-1 (IL-1), interleukin-6 (IL-6) and TNF-alpha (12).
Can diet reduce medication needs?
Immune system regulation is complex and involves over 1,000 genes, as well as many biomarkers. Bioactive compounds found in high-nutrient foods and supplements can have a profound impact on your immune system’s regulation and may help reset the immune system. Even in severe cases, bioactive compounds in foods may work in tandem with medications to treat autoimmune diseases more effectively and help reduce dosing of some immunosuppressives, minimizing potential side-effects.
This is not hypothetical. I have seen these effects in my practice, where patients have been able to reduce – or even eliminate – immunosuppressives by altering their diets.
References:
(1) niaid.nih.gov. (2) J Autoimmun. 2007;29(1):1. (3) epocrates.com. (4) J Rheumatol 1999;26(8):1705-1714. (5) Front Nutr. 2017; 4: 52. (6) Am J Clin Nutr. 2009 Aug;90(2):415-424. (7) Drugs. 2003;63(9):845-853. (8) Gut. 2003 Jul;52(7):975-980. (9) Antonie Van Leeuwenhoek 1999 Jul-Nov;76(1-4):279-292. (10) Gut. 2002;51(5):659. (11) Arch Intern Med. 2007;167(5):502-506. (12) Nutr Metab (Lond). 2010 May 13;7:42.
Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.
