Case Study Excerpt: Gut Protocols for Autoimmune Disease

Autoimmune disease, once thought of as rare, has seemed to grow rapidly over the past several years. Over 14,000 Americans were tested for the antinuclear antibody (ANA) which is one marker of autoimmunity, in three different time periods. The number of ANA positive patients increased from 22 million in 1991 to 41 million in 2012. While not all those patients have/had active autoimmune disease, the elevated ANA indicates a risk for the development of an autoimmune process. The researchers gave no specific cause for the increase, but I suspect the SAD and its effects on the gut microbiome as one contributing factor.

Autoimmune disease results when the immune system can no longer distinguish friend from foe. Instead of attacking the viruses, bacteria and parasites that could cause harm, the immune system begins to attack the body’s own healthy tissues and organs leading to a variety of symptoms and serious consequences. Autoimmune thyroid disease and type 1 diabetes are the most common autoimmune conditions, but there are over 100 different identified autoimmune diseases.

Occasionally, I am contacted by patients with rare autoimmune conditions that seemingly have no treatment. But I believe targeting the gut with nutrition- and lifestyle-related strategies for those with any autoimmune disease should be the first line of defense as it will always improve symptoms and quality of life, but can also lead to disease reversal.

Roni struggled with worsening rheumatoid arthritis (RA) symptoms for one year prior to our visit. Her hsCRP had gone from 5 mg/L to 27 mg/L and she had a very low vitamin D level of 27.9 ng/dL. Celiac disease and thyroid dysfunction had been ruled out. She had a very stressful job, wasn’t sleeping well, and reported a 30-pound weight loss since her diagnosis. She felt very stiff in the morning, taking up to an hour to get moving upon waking. She was already trying to follow a gluten- and dairy-free, plant-based meal plan, but admitted to having sweets at times, especially when she wasn’t feeling well. I suspected significant gastrointestinal (GI) dysfunction and unmanaged stress as root causes of the extreme inflammation. GI Map stool testing and salivary cortisol testing were recommended but declined due to cost.

I targeted her GI and adrenal function with the 5-R protocol and utilized a variety of nutrients to address the inflammation, gut health, and vitamin D deficiency. My initial plan included:

Stress Management and Sleep Strategies

1. Meditation, working up to 20 minutes twice per day
2. Aromatic lavender essential oil before bed
3. No blue light at least one hour prior to bedtime
4. Holy Basil or chamomile tea (two teabags) before bed
5. Magnesium glycinate 200 to 400 milligrams before bed

Inflammation and Gut Health Strategies

1. Comprehensive elimination diet for eight weeks with 1,000 milligrams buffered vitamin C daily for the first week
2. Ginger 500 milligrams BID to increase Bifidobacterium, Enteroccocus, and the production of SCFAs
3. Curcumin 500 milligrams three times per day to reverse gut dysbiosis and enhance the microbiota-gut-brain axis
4. Selective Kinase Response Modulator one cap three times per day
5. High quality fish oil 3,000 milligrams per day
6. Vitamin D3 5,000 international units with K2 daily for three months
7. Extra virgin olive oil two to four tablespoons per day to stimulate gut microbiome diversity
8. High-potency probiotic supplement and two tablespoons fermented foods each day
9. Prebiotics daily, choosing from under-ripe bananas, raw dandelion greens, raw leeks, raw jicama, raw chicory root, raw garlic, raw or cooked onions, and/ or raw asparagus

After four weeks, Roni had experienced some symptom improvement, but the hsCRP remained quite elevated. I recommended continuing with the initial strategies and added the fasting mimicking diet (FMD) protocol. My patient declined the FMD due to cost, so I recommended a 12-hour overnight fast daily and a longer 16- to 18-hour fast twice per week. Roni has incorporated the above recommendations and over the past one year, her hsCRP is down to 1 mg/L. Her symptoms are much improved and she is able to move well upon waking. While she remains on a Janus kinase inhibitor, she feels the nutrition- and lifestyle-related changes have been extremely helpful for symptom management. Her maintenance meal plan is a mostly plant-based, modified Mediterranean diet excluding gluten, dairy, red meat, and nightshades.

 Editor's Note: This is an expert from the e-book, Nutrition Foundations for the Gut Microbiome. To read more, click here.

About the Expert

Kellie Blake is a registered dietitian, licensed to practice dietetics in West Virginia, Ohio, and Kentucky. She graduated from the University of Kentucky in 2001 with a Bachelor of Science in Dietetics and in 2018, she became an Integrative and Functional Nutrition Certified Practitioner.

In 2015, Blake was recognized as a Top Ten Dietitian by Today’s Dietitian Magazine. Blake practices in a variety of areas including psychiatry, hospice, and enteral and parenteral nutrition. She is also the Chief Nutrition Officer for KyKana Corporation, a Kentucky-based company on a mission to bring health and healing to Appalachia.

In addition, Blake owns a private practice, NutriSense Nutrition Consulting, LLC, where she utilizes her functional nutrition training to assist clients in preventing and reversing chronic disease. Blake has used functional medicine and nutrition to reverse her own autoimmune disease and is passionate about sharing the food as medicine message. She is the author of The Psoriasis Diet Cookbook and maintains a nutrition and lifestyle blog and Instagram account.