Tuesday, September 2, 2014

PIP Goes AIP (Autoimmune Paleo)

Happy September!
When I last posted back in the beginning of April, I'd just started the Autoimmune Paleo Diet (AIP, for short), and I'd also just started working with a functional medicine practitioner. This whole process has been so interesting and encouraging for me. I'm now nearly 5 months into the process and I've seen some big improvements that weren't happening on Paleo/Primal. I needed to dig deeper into my autoimmunity and blood work and my diet needed some tweaking. This post is a longer one, so sit back and dig in.

Functional medicine lab work time!

It had been a long time since I'd had any labs run, so the first order of business was doing some comprehensive blood work, as well as a series of Cyrex Labs arrays to look at my gut lining, gluten sensitivity, potential gluten crossreactive foods and food sensitivities, chemical/heavy metal autoimmunity, and multiple tissue autoimmunity. It cost me a pretty penny, but I'm absolutely glad I did it. I also filled out extensive symptom and neurotransmitter profile questionnaires.

My blood work didn't reveal anything too scary: an electrolyte imbalance, and high-ish iron (not hemachromatosis), which my doc felt indicated inflammation. However, she was concerned with my low blood pressure. My blood pressure has always been pretty low and no doctors or practitioners, holistic or otherwise, have ever mentioned that it's not a good thing. My doc explained that when blood pressure is too low, nutrients and glucose aren't able to be effectively delivered into the tissues (perfusion), and extremities (like my brain) might not have sufficient circulation. In fact, she felt that my neurotransmitter questionnaire indicated poor brain circulation resulting in lowered neurotransmitter levels. Poor circulation can be the main cause of cold extremities and brain fog. Read more here.

She put me on a supplement to increase circulation and endothelial nitric oxide (eNOS), which also works to modulate the immune system, which she has me take first thing in the morning, along with an adrenal supportive cream, and then do a few minutes of intense exercise to produce an opioid response (which dampens inflammatory cytokine production) and increase circulation/perfusion. So, there really is something to the idea of "getting your blood moving!"

I am also on a general immune modulation regimen involving curcumin/resveratrol, glutathione cream, and a formula to help the body recycle glutathione, as well as neurotransmitter support for GABA, serotonin, and dopamine. And, of course, there are gut health supplements and probiotics. I won't go into the particulars of all of the supplements because they're particular to me and might not be right for someone else.

We're working on my circadian rhythms, which, admittedly, I've never been the best about. In the morning, after taking my supplements and doing a few minutes of intense exercise to increase perfusion/circulation, I go outside and get some sunshine and take some time to read, do qigong, hang out with my cat, get my bare feet on the earth. In the evenings, I turn down the lights and, if I'm watching tv, I wear some blue-blocker glasses to reduce blue light exposure, which can tell your brain not to release enough melatonin.

The Cyrex tests helped me to troubleshoot my diet. Even though I already knew gluten was a problem for me, the Wheat/Gluten Proteome array, which is the most comprehensive gluten test available, showed that I had antibodies to gamma-gliadin, and transglutaminse 2 and 3, so it's an autoimmune gluten reaction- not something to mess around with. It's kind of nice to have the lab tests to prove gluten sensitivity, with all the gluten-free backlash going around.
I also learned that I cross-react to casein and whey proteins as if they were gluten. About half of people with gluten sensitivity also react to casein because the proteins are so similar in structure. Thankfully, the rest of the foods tested didn't show many sensitivities- just potato and soy.

The chemical and metal autoimmunity panel came back fine, as did the leaky gut panel (I'd been on Seacure for awhile), but the multiple autoimmunity panel showed all kinds of things going on. It was kind of like opening Pandora's box and seeing where you could potentially develop future disease. Pretty intense!

I had low level ("predictive") antibodies to a lot of tissues: thyroid (not surprising, as I have Hashimoto's), parietal cells, phospholipids, osteocytes, synapsin, ASCA/ANCA (anti-saccharomyces yeast antibodies, found in Crohn's and Ulcerative Colitis), and fibulin.
I also had much higher levels of antibodies to platelet glycoprotein, and alpha/beta tubulin, (the second one is commonly found in Hashimoto's). Whew!

It was a little overwhelming (and scary) seeing all of this, but if you know this information when the antibodies are only in the predictive range (which can indicate future disease development up to 10 years out), you can hopefully thwart the process from progressing. That's the thing about autoimmunity: it's progressive and rarely sticks to just one tissue, as my panel most definitely showed. I can't stress this enough: if you have any kind of autoimmune condition, you're likely to develop more if you don't intervene.

Now, on to the Autoimmune Paleo Diet front.

I started AIP at the beginning of April and I went all in immediately. I'd been dragging my feet about doing it, so having my doctor tell me to do it was a good thing. I'm much more compliant if the orders are coming from someone who is not me ;) For the first few days, I had a weird kind of fatigue and a hungry-no-matter-what feeling. It felt as though I was having food withdrawals (I'm going to guess from casein). It passed quickly, though. I got into the routine of not eating any dairy (except cultured ghee), eggs, nuts, seeds, alcohol, chocolate, and nightshades (grains and beans were already not something I ate on a regular basis). It was more of an adjustment than I initially realized, because so many condiments and spices I was used to using were now off limits. I've done Whole 30, but, let me tell you, Whole 30's got nothing on AIP! AIP is a whole other level of food vigilance. You get really used to it, though.

In order to cope with the restrictions and be kind to myself, I decided to add in some foods I don't normally eat a lot of- starchy foods like green and ripe plantains, more fruit than I'd normally eat, as well as a bit of dried fruit, which is something that normally never occurs to me to eat. Dried figs became my treat when I needed a treat. Or ripe plantains sauteed in casein-free ghee with cinnamon and homemade coconut milk caramel sauce.

After four solid months, I'm now in a phase of playing with some reintroductions. Some have gone well (black pepper, coffee, a few seed-based spices, small amounts of wine, and eggs), and some haven't. I've learned that chocolate, which I never noticed to be an issue before AIP, has consistently induced IBS symptoms the following day after every attempt I've made with it. Doesn't matter the form it's in- if it's chocolate, my gut will be rumbling the next day. This is disappointing, not to mention weird, since I've never had IBS before, but chocolate is on the list of IBS trigger foods. Sometimes you really have no idea how a food affects you until you haven't eaten it in months and your system has had a chance to settle down.

When I was on vacation a month ago, I jumped protocol and ate a lot of nightshades in a short amount of time due to eating out (not recommended, though!). I didn't notice any reactions to them, which was surprising because I also had my annual summer insomnia bout happening. For me, lack of sleep usually increases muscular inflammation, but I didn't notice any. I'd still like to give nightshades a proper reintroduction, though.

I hope that as I continue to heal I'll have more successful reintroductions. I was encouraged after chatting with some other AIP'ers who told me stories of failed initial reintroductions only to later be able to eat those foods with no problems. Maybe there's still hope for me and chocolate...

Improvements and progress:

So, after all of the tweaks, am I seeing improvements in my health? Why, yes, I am! I still have a way to go, but the improvements have been substantial enough that it's been more than enough motivation for me to continue on this particular path. Here are the improvements I've experienced:

-Better skin. My skin has always had some degree of breakouts and, though ditching gluten and going paleo eliminated my cystic acne, it didn't eliminate my breakouts, though they were certainly diminished. I felt ok about my skin, but there was room for improvement. On AIP, my skin clarity has improved quite a lot. I now rarely break out on my shoulder blades or across my chest (not that these were bad breakouts, but they were fairly frequent) and the breakouts I do get are so minor- just a tiny little blemish here and there- no angry red monsters.

-Weight loss. This has been really thrilling! Over the autumn and winter, I'd slowly gone up in weight and size and I wasn't eating any differently than I'd been eating. This followed the big autoimmune flare I had at the end of last summer. Even though I've never been truly overweight, when my weight starts climbing, I know it's usually related to my Hashimoto's. That's a scary thing, knowing that your weight is being controlled by your immune system and that little gland in your neck, rather than diet and exercise. So many of you with Hashimoto's know what I'm talking about! Anyway, this extra weight was not budging easily, despite adding more exercise.

After starting AIP, the weight slowly but surely melted off, at about a pound a week, without watching what I ate or even exercising much. Granted, it's not the fastest weight loss ever, but it was so exciting to feel like it was happening because my body was working better! As of today, I'm down 17 pounds, most of which I lost in the first 3 months. I've especially lost a lot of belly fat, which is where I tend to gain. I've lost 3.5 inches of belly fat. Whoohoo! Even though I have a little vanity belly fat I'd still like to lose, I'm now at a size and weight that feels good to me.

-Cellulite. Ok, so this one's pretty exciting. I've always had some cellulite, but it never bothered me until my late 20's when it suddenly got more severe. After going paleo, I was disappointed that I wasn't one of those women who magically lost their cellulite. In fact, it seemed to be getting more severe and spreading across a larger area of skin for the past couple of years. Even the skin on my inner forearms would dimple if I squeezed it. Having slender arms, this was disturbing, as if maybe there was an inflammatory process going on (my forearms certainly didn't have excess fat). I wondered if my collagen was breaking down, or if it could really be myxedema accumulating beneath my skin, or if my fat cells were just inflamed.

Anyway, even before I lost a significant amount of weight, I noticed that my legs were looking smoother. They've continued to improve to the point that now I'd say my cellulite is pretty mild. I feel so much better about it. My inner forearms no longer dimple when I pinch the skin. I don't know exactly what caused the improvement, but I'd guess that the combination of eliminating dairy and other inflammatory foods, weight loss, and collagen supportive foods like bone broths and collagen hydrolysate powder have all worked their magic together.

-Better muscle tone. This one is fascinating to me. I've never had naturally great muscle tone. I'm a classic ectomorph, long and lanky at 5'9". I've definitely been skinny-fat or just plain skinny. Muscle tone has always taken some work to come by. Switching from vegetarianism/veganism to paleo made it easier for me to gain muscle, which was nice. Now, for some reason, I seem to have better muscle tone despite infrequent workouts (though I do a fair amount of walking). I have muscle definition that I've only ever previously had after months of working out. I've never really had a line of muscle definition down the outside of my thigh before, and now I do! My guess is that my muscles weren't getting enough nutrients due to poor profusion and maybe poor absorption (remember those parietal cell antibodies? They attack HCl-producing cells in the stomach). At any rate, I'm really enjoying my sudden muscle tone.

-Energy. This is still touch-and-go, but I've started to have more energy. I noticed an increase after adding a thiamine (B1) supplement to my regimen, based on this article by Dr. Izabella Wentz, detailing a study that found that thiamine relieved fatigue in Hashimoto's patients. I still have off days and random drops in energy, but I've also had more really good days. I'm learning to monitor what kinds of things are likely to drain my energy, such as sitting in front of the computer too long, not eating enough calories, having draining conversations, stress, etc, and which are helpful for increasing my energy (time outside barefoot on the earth, getting to bed earlier, qigong, doing an inspiring activity...).

Room for improvement:

I'm committed to this path long term, which has really helped me to surrender to the process and let go of feeling like I should have reached a place of balanced health by now. I have my impatient moments and bad days, but it's ok.

As I progress, I'm hoping that my hormones will improve. I can tell I'm still low in progesterone by my often short cycles. There is still room for improvement with my sleep quality- it's not terrible, but I'd like to sleep more soundly. My doc thinks that some midbrain overactivation is probably at play regarding that. Even though I have nothing close to the kind of brain fog I used to have, my brain's clarity still could use a boost at times. Maybe once I stop making synapsin antibodies, my synapses can do their job properly.

Digestion/elimination is the final area I'd like to see more improvements. I am doing gut/brain exercises that restore signalling to the vagus nerve, which connects the brain and gut. These include gargling, singing loudly, and gagging (fun, I know!). All of these can get those signals moving again. I just have to remember to do them daily, which is easy to forget.

I'll be writing more about autoimmune healing and lifestyle in upcoming posts and I'll be posting recipes and reviewing some great books that I've read in recent months, including The Autoimmune Paleo Cookbook, and Why Isn't My Brain Working. Stay tuned!