Eating Paleo for Immune Disorders: Our Approach

Our Weekly CSA Haul: Paleo Means Lots of Veggies!

I've been promising this post for a long time, as readers frequently ask about our diet. As background, my son and I (we both have ME/CFS and Lyme disease, plus he has two other tick infections) work with a Registered Dietician who also has an MS in Biochemistry. In short, she is brilliant and understands how all of our complicated health problems fit together and affect us and how diet fits into the puzzle. In addition to ME/CFS and tick infections, we both struggle with chronic yeast overgrowth (aka candida), due in part to long-term antibiotics and in part to the immune dysfunction of ME/CFS. To be clear, my intent with this post is to share what we have learned from our dietician and additional research about how diet affects us and our medical problems and how we eat to try to address some of those problems. Our approach is not necessarily right for everyone (for instance, I know some patients with a sensitivity to FODMAPs, which requires a different diet).

I would call our diet a modified Paleo diet. It is also meant to help reduce inflammation (which research shows is a huge factor in ME/CFS) and is an anti-candida diet, for getting yeast overgrowth under control. The Paleo diet has gotten a lot of press and plenty of patient testimonies for being the best diet for those with immune disorders, like ME/CFS. This article summarizes some of the recent buzz about eating Paleo for autoimmune disease (note that the immune dysfunction in ME/CFS is not precisely autoimmune, but it is an immune disorder).

What Is the Paleo Diet?
You may have heard of the Paleo diet before - it has been in the news for decades. Paleo is short for Paleolithic, and the basis for the diet is supposed to be what early man ate, before McDonalds, refined sugar, and other health hazards came along. Many people think that Paleo is a high-protein, meat-based diet, but that isn't really accurate. I wouldn't even call Paleo low-carb: rather, it is substituting healthy, high-quality, low-inflammation carbs (i.e fruits and vegetables) for less healthy ones like starches, refined grains, and sugars.

What is Paleo then? Basically, the Paleo diet means:

• No dairy
• No grains
• No refined sugars
• No legumes
• No refined oils 
• No soy
• No alcohol

So what do you eat on a Paleo diet?

• Lots of vegetables
• Some fruit
• Lean meat (preferably grass-fed) and poultry
• Fish and seafood
• Eggs
• Nuts & Seeds
• Plenty of healthy fats, like coconut, olive oil, fish oil, and avocado

When I began eating Paleo, I did not start eating more meat/protein than before - I mostly shifted my carbs from grains to additional vegetables. So, this is not the Atkins diet!

Why Is Paleo Good for Immune Disorders, Like ME/CFS?
This kind of diet often works well for those with ME/CFS and other immune disorders for several reasons:

• It eliminates many (though not all) common allergens, and our immune dysfunction makes us extra-susceptible to food allergies and intolerances. One study showed a full 30% of young ME/CFS patients were dairy intolerant.
• It eliminates many (though not all) inflammatory foods. Gluten and other proteins in grains, dairy, and sugar are all highly inflammatory in the body when consumed. We already have high levels of inflammation that make our illness worse. The right diet can help to reduce inflammation.
• It eliminates refined grains, dairy, and sugars, which contribute to yeast overgrowth, a common occurrence in ME/CFS and other immune disorders.
• Gluten, gliadin (a similar protein in oats), and casein (a protein in milk) all block one of the methylation pathways. Eliminating these can help to improve methylation, which is very important in ME/CFS. In the words of our dietician: "Dairy inhibits the uptake of cysteine by neurons which impairs the neuronal production of glutathione. Considering the brain and its neurons is the most aerobic organ and glutathione the most important antioxidant, the brain becomes subject to severe oxidative stress. Casein also blocks the reduced folate receptor and the transport of reduced folate into neurons." (I told you she was brilliant).
• Some immune-specific Paleo diets also eliminate nightshades, like tomatoes, eggplant, and bell peppers because they are inflammatory. We haven't gone that far.

How Is Our Diet Different Than Typical Paleo?
As I said, our dietician laid out our diet plan, starting with the basics of Paleo and then adding or subtracting from there, based on our own needs which I outlined above. So, some differences between a typical Paleo diet and how we eat:

• Almost no sugar. Regular Paleo includes small amounts of natural sugars, like honey, maple syrup, and agave. Because of our chronic yeast overgrowth, we have to limit even those (and fruits, too). I sometimes use a little bit of honey (which has an antifungal effect and doesn't encourage yeast like other sweeteners), and we often use stevia, a natural sweetener that does not encourage yeast (and might help with Lyme disease, too).
• Limited beans and other legumes. Though strict Paleo includes no legumes, we used to eat a LOT of beans, so our dietician said we could have them 1-2 times a week.We probably only eat them about once a week now. My poor son was so miserable with his dietary restrictions that our dietician told him he could have his peanut butter back! He's happy now.
• Limited red potatoes. Again, strict Paleo is no potatoes, but our dietician said we could have red potatoes (less starchy than the other types) once a week.
• I use a little butter. Ghee (clarified butter with no casein or lactose) is allowed on Paleo, but since there is almost no lactose in butter, I use it as is--sparingly--especially in baking (yes, you can bake with Paleo!)
• Limited fruit, again due to the yeast overgrowth. Pears are fine every day--they don't encourage yeast. Apples, melon, mango, and blueberries are also good choices in limited amounts if you have yeast problems.

Note that our son was on a super-strict anti-yeast diet for his first month or two because he was in such terrible shape; his mitochondria was trashed from too many years of antibiotics (for tick infections) and he had severe yeast overgrowth. He was almost completely incapacitated and desperate to feel better. It worked and got him "unstuck" and then he gradually added things back in to get to the diet I describe here.

So, as you can see, you can make adjustments to suit your own needs. It's really not important to me whether I eat exactly like Paleolithic man or not! I am just trying to do what's best for my health, in a way that is sustainable for us.

But What Do You Eat For...?
People often ask me "what kind of snacks do you eat?" or "what can I eat for breakfast?" Here are some quick ideas from our own kitchen. This is by no means a complete list - just to give you some ideas to start with:

Fried Eggs with Veggie Hash for Breakfast

Breakfast

• Most days I eat veggies and eggs for breakfast, in many different varieties. You can make an omelet, but I usually make a scramble just because it's easier. I saute onions and veggies then add in eggs and scramble it all together. My son likes ham or bacon (nitrate-free) with onions, zucchini, and roasted red peppers. My favorite is a combination I first had at a favorite diner: onions, zucchini, artichoke hearts, roasted red peppers, and kalamata olives (yum!). Our whole family enjoys Mexican eggs made with chorizo, onions, bell peppers, mild green chiles, and a bit of salsa with avocado on top. See? Not boring at all! With all those fiber-rich veggies, you won't even miss the toast.
• When I'm in the mood for fried eggs (which I love), I make a veggie hash on the side, with roughly chopped onion, pepper, zucchini, and one red potato (or sometimes, turnips or sweet potatoes, in season). For a treat, my husband and I sometimes have a different version of Mexican eggs, like Huevos Rancheros, with mashed beans covered with two fried eggs and homemade salsa made with tomato, avocado, cilantro, and lime juice.
• Paleo Waffles - when the kids are here, we bust out the waffle iron! Against All Grain (just search for waffle) has a bunch of delicious waffle recipes - we have served these to guests (even picky kids!) who never knew they were grain-free.
• Our favorite Chocolate Banana Smoothie (recipe at the link) - this is a bit high in sugar (fruit) for me to eat often, but it's a favorite at our house.
• I do cheat about once every two weeks and treat myself to a bowl of oatmeal, which I love. I use whole oats and make them as Paleo-ish as possible by adding coconut oil, unsweetened coconut, flax seeds, walnuts, and blueberries or raspberries. I sweeten it with stevia and flavor it with cinnamon and a teaspoon of alcohol-free vanilla.

Our Fave Paleo Smoothie with Veggie Chips

Lunch

• I often eat a deconstructed sandwich without the bread - turkey slices (or canned tuna or salmon) with lettuce, tomato, avocado, or whatever other veggies I have on hand.
• Our favorite Chocolate Banana Smoothie - it works for breakfast, but we eat it more often for lunch. When my son comes home from college for lunch, I make a double-smoothie for us to share! I sometimes have veggie chips (like Terra brand) on the side for a bit of crunchy and salty (though they are not strictly Paleo due to the oils used).
• Homemade soup - most store-bought soups contain rice or pasta or cream, but in the winter, I make a big pot of soup at the beginning of the week (some sort of meat with loads of veggies and broth) and have it for lunches.
• Left-overs from dinner the night before. When it's just me at home for lunch, this is my usual go-to. I continue to cook for three, even though our youngest is now in college, and save the extra serving for lunch the next day.
• Salads - the sky's the limit! Start with greens and pile on all the veggies you want, plus some protein and a vinaigrette made with olive oil. Some of my favorites include Cobb Salad (turkey, hard-boiled egg, bacon, tomatoes, cucumbers, and avocados) or Nicoise Salad (tuna, hard-boiled egg, lightly steamed green beans, tomato - I usually leave out the red potato).

Cobb Salad for Lunch or Dinner

Dinner

• We often go simple and just sub a second vegetable for the starch in a typical dinner. So, grilled (or broiled or baked or...) meat or fish with two vegetables on the side (or a cooked vegetable and a salad).
• Dinner Salads - we do this a lot in the summer, when we have lovely fresh lettuce and veggies from our local farm. See my favorites under lunch, but we eat lots of different salads. Our favorite dinner salad is a bed of lettuce with tomato, cucumber, carmelized onions, a small bit of blue cheese (yes, a cheat but it has almost no lactose in it), and sliced steak on top.
• Homemade soup in the fall and winter.
• Modified recipes: I still use some of my old favorite recipes, with slight modifications. We eat stir-fries and curries, just without the rice underneath (or with cauliflower "rice" instead). I might leave out breadcrumbs or cheese or other non-Paleo ingredients and add in extra veggies. I find that sources of healthy recipes, like Cooking Light magazine or Curtis Stone's cookbooks (both favorites of mine) are often naturally Paleo or can be easily modified.
• Find Paleo substitutes for your favorites, like cauliflower rice for rice (recipes in the Paleo cookbooks below) or zucchini noodles made with a spiralizer instead of pasta.
• Paleo recipes. See below for suggestions and links.

Ground Beef and Cabbage Soup for Dinner with Left-overs for Lunch

 Snacks

• Nuts and seeds - lots of protein and portable, though they should be limited if you are trying to reduce inflammation or avoid oxalates. Pistachios and macadamia nuts are lowest in oxalates. Be sure to get salted nuts to help with OI!
• KIND bars with 5g of sugar - they make several varieties now that are low in sugar. Our favorite is the Dark Chocolate Sea Salt. Still a bit too much sugar for me, but they come in handy when traveling. They are mostly made with nuts, so the same comments above apply. There are other brands of Paleo snack bars available now--just read the labels to make sure you aren;t allergic or sensitive to any of the ingredients.
• Coconut yogurt (unsweetened) with fresh fruit. I just discovered yogurt made from coconut milk, and I was thrilled! So Delicious brand makes several unsweetened varieties. I cook with the plain and have the vanilla flavor for snacks. The downside is that it doesn't have the high protein that yogurt made from milk does.
• Apple or pear and sunflower butter or nut butter. One of my favorite snacks this time of year especially: I cut up an apple and dip it in a tablespoon of sunflower butter - yum!
• Jerky - there are lots of different varieties, including turkey and salmon. Trader Joe's has a great selection. Look for a brand with no nitrates and low or no sugar.
• Veggie chips, like Terra brand, can satisfy the desire for crunchy, salty snacks (I found that Target has the best prices, though Amazon is a close second).
• Although legumes are not strictly Paleo, I occasionally have a bit of hummus with raw veggies. 
• A friend suggested toasted nori (seaweed) - I need to try that.
• Extra-dark chocolate (86% cacao or higher) - yes, you can eat chocolate! Use raw cacao powder in baking and smoothies. I sometimes use unsweetened baking chocolate in recipes or to make a simple chocolate sauce (with stevia). And I eat a square of dark chocolate every night with my herbal tea - just choose 86% or higher cacao (there is less than a gram of sugar per square in it). My favorite is Ghiradelli Intense Dark 86%. Bonus: Dark Chocolate is one of the best anti-inflammatories in the world! It also contains iron, magnesium, and zinc, so as long as it's dark (i.e. less sugar and more cacao content), then it's actually very nutritious!

My evening treat: herbal tea and extra-dark chocolate

Paleo Recipe Resources

Two of my favorite Paleo cookbooks are Everyday Paleo and Against All Grain (links are to my own reviews for details). These cookbooks include many Paleo versions of favorite foods, including breads and desserts (see my reviews for lists). I also love Everyday Paleo: Thai Cuisine and use it almost every week (but I haven't reviewed it yet). I have also found lots of recipes that are naturally Paleo or easily modified in Curtis Stone's What's for Dinner?

Two Favorite Cookbooks: One Regular and One Paleo

There are LOTS and LOTS of blogs and websites devoted to a Paleo diet with loads of recipes. One I use is Against All Grain, but there are many others, too. Whatever recipe you are looking for, just type it into your search engine with Paleo, and you will probably get lots of results.

Curtis Stone's Squash Curry - So Good!

Some of my own Paleo recipes:

• Chocolate Banana Sunflower Butter Smoothie (did I mention we love this?)
• Paleo Coconut Custard
• Turkey and Wild Rice Soup (wild rice is not a grain - it's actually a grass so OK on Paleo)
• Mostly Sugar-Free Dark Chocolate Bark (great treat)
• Paleo Pumpkin Coffee Cake (not my recipe but SO good!)
• Paleo "Peanut Butter" Cups (at the bottom of the post)
• Roasted Sausage and Vegetable Dinner (a favorite in our house!)

My Dark Chocolate Bark

Eating this way has helped both my son and I quite a bit. It has helped us to get our yeast overgrowth under control (along with other approaches), helped to improve methylation, and reduced GI symptoms (eliminating dairy 12 years ago completely eliminated my GI problems!). Many people also find they lose weight on a Paleo diet, due to getting rid of refined carbs, flour, and most sugar and eating more vegetables.

I hope that will answer some of your questions and get you started on your own healthy eating plan. This was a long post, but I'm sure there are things I've forgotten, so please leave any questions or comments in the Comments below, and I will be happy to answer.

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