Supplements for Autoimmune Disease; Contraindications and Bioindividuality
As you might imagine, I get some pretty interesting questions about supplements, and I got one recently that made me think – I should write about this / do a video! If you want to watch the video of me in my temporary office (aka a coffee shop in Kona), you can do that here!
The recap, however, is below.
There are three different topics I think it’s important for you to understand about this –
What supplements you may want to avoid because of their crappy fillers, and those that are definitely not AIP compliant
Immune stimulating herbs and compounds that should generally be avoided, and why
The most bio-available (read: absorbable) forms of vitamins that are important for autoimmune regulation – and which ones are easiest to get from food!
1. Fillers and ingredients that are contraindicated for protocol itself:
If you don’t already know, the AIP protocol excludes grains, including all gluten-containing grains and corn, and legumes including peanuts and especially soy.
Case study: My client Emily had been on a gluten free diet for quite a while, and was feeling amazing, telling us that gluten was probably a big trigger for her. At one point we reviewed all of her supplements, and it turns out she was taking a crappy One-A-Day brand multivitamin. She switched to a higher quality one at my suggestion, and had multiple days of migraines and detoxing after discontinuing the One-A-Day! Turns out there was gluten in the vitamin tablet! Yikes. It was a big learning experience for both of us.
Honestly the cheaper the supplement is, the more fillers and weird ingredients it will often have! Sometimes there are even gluten* ingredients in supplements. I know, so weird, but it’s cheap so they use it to add bulk. There can also be ingredients that cross-react with gluten, which is to say that they look like gluten to your body, so even if you’re not expressly sensitive to those foods – if you have a gluten sensitivity they can trigger a gluten-like reaction!
*Note: many researchers now believe that gluten sensitivity can trigger any autoimmune disease, so if you have an autoimmune diagnosis, I cannot implore you strongly enough to go 100% gluten free!
Corn is one of those foods that can cross-react with gluten, so be on the lookout for maltodextrin (usually made from GMO corn), and anything with “malt” in the name can have gluten.
Look out also, for probiotics that come pre-packaged with prebiotics, be on the lookout for ingredients like FOS, inulin and white kidney bean extract. The bean extract obviously is not compliant in the elimination stage of AIP, but prebiotics in general can exacerbate gut issues for people who don’t have healthy digestion. Especially in cases of IBS (Irritable Bowel Syndrome) or SIBO (Small Intestinal Bacterial Overgrowth), I recommend avoiding prebiotics unless under the care of your health care practitioner. Legumes can cause digestive distress – even in healthy people – so they are excluded in the elimination phase.
A note about quality: when your practitioner suggests a particular brand or supplement line, and you go to the drugstore to try to find it “cheaper”, you may be shooting yourself in the foot. For those of us who work with professional supplement lines, we have generally vetted each company we suggest, in order to make sure that they are practicing good quality control, using the highest quality ingredients, and NOT using crappy fillers. Even being able to know that the company manufactures the supplements in a dedicated gluten-free facility can give you so much peace of mind!! Not to mention being incredibly important for people with celiac and other forms of gluten intolerance.
2. Let’s move on to known immune stimulating herbs and other compounds – sometimes some of these will be okay for a person with autoimmune disease, but you definitely want to be working with your health care team to understand the reasons why and why not.
Actually what prompted me to talk about this topic this week, was that someone messaged me asking about aloe vera and autoimmune disease. At first it was hard to tell what she wanted to know, but it became clear that she is a representative for one of those multi-level-marketing companies that sells an aloe product, and she was looking for some information about how it works and how it could help people with autoimmune.
Lest you become confused by my agreeable and diplomatic tone, I heartily discourage people from buying and selling supplements through MLM companies. People who work for these companies are often encouraged to call themselves health coaches, with NO TRAINING except what the company has given them. And what is the motivation of the company? To make money. So they don’t train them on anything that could ever possibly reflect badly on the company. “Contraindications? Don’t need ‘em. Bioindividuality? What’s that? Do this 30 day cleanse, exactly the way I have outlined it here, and you’ll feel great! How do I know? Because that’s what they told me to say.” It takes only a dash of critical thinking to understand that these cookie cutter programs aren’t for everyone, and that an untrained “health coach” is a liability disaster waiting to happen. /endrant
Obviously I didn’t say all of that. But what’s true about aloe vera is that it is a known immune modulating herb, which can really be a problem for someone in an autoimmune flare. I encouraged her, as a layperson, to literally never tell anyone with an autoimmune disease to use it. I may have mentioned liability. #lawyerwife
She asked me “does the quality matter”? Like, as if, the property of the herb itself could somehow change if it were “higher quality”, like she’d of course been taught that her product was. The truth is, the higher quality / more pure one of these compounds is, the more of the immune-stimulating properties it will have!
Listen, I know we all have our own health journeys and supplements can be SO TRICKY and it’s SUCH A RELIEF to just have someone tell you what to take. But I have to say, please please PLEASE use your best critical thinking when your Aunt Sue suddenly is an expert on goji berry extract and wants you to join her downline. Does she carry liability insurance? Are you signing a waiver if you take goji berry juice shots at a house party with Aunt Sue? There are those of us who take this responsibility very seriously and are way more concerned about your health than we are about the latest fad superfood supplement!
The point of all of this is, if you’re having a flare, especially, you want to avoid immune-stimulating herbs, because they are going to be “pumping up” your immune system – which is clearly already feeling pretty hulk-smash-y.
See also, this list (reprinted with permission from autoimmune wellness):
Known immune modulating herbs & compounds
Herbs known to stimulate the immune system:
Aloe vera (aloe barbadensis)
Ashwagandha (withania somnifera)
Astragalus (astragalus propinquus)
Chlorella and other algae
Echinacea (echinacea angustifolia)
Elderberry (sambucus nigra)
Ginseng (panax ginseng)
Goldenseal (hydrastis canadensis)
Grape seed extract (citrus paridisi)
Green Tea Extract (camellia sinensis)
Holy Basil (optimum tenuiflorum)
Lemon Balm (melissa officinalis)
Licorice Root (glycyrrhiza glabra)
Maca Root (lepidium meyenii)
Marshmallow Root (althaea)
Medicinal Mushrooms (shiitake,maitake, etc.)
Slippery Elm (ulmus rubra)
White Willow Bark (salix alba)
Compounds known to stimulate the immune system:
Pine Bark Extract
Again, some of these herbs and compounds might be totally fine for you – but it’s best to work with a skilled practitioner instead of trying to figure it out on your own.
3. Vitamins that are important for autoimmune, and how to know when they are high quality!
One of the reasons that the Autoimmune Protocol is so powerful is that it’s one of the most nutrient dense dietary protocols you could possibly follow. We’ve talked about this before, but in autoimmune disease, not only are you probably not eating all of the nutrients that your body needs in your diet, you have leaky gut – aka malabsorption – so you’re DEFINITELY not absorbing those nutrients! This is a huge problem, because as I’ve stated before, the immune system uses more nutrition than any other system in our bodies – ESPECIALLY when it comes to regulation. (Immune DYSregulation is the hallmark of every autoimmune disease.)
There are certain vitamins that are super vital to immune function & regulation; specifically fat-soluble Vitamin A (retinol) & Vitamin D. Both are found in healthy animal fats, pasture-raised lard and beef.
The fat soluble vitamins are, of course, A, D, E, & K. When you get diagnosed with an autoimmune disease, if your doctor is into vitamins, you may be prescribed Vitamin D – often without getting your Vitamin D levels tested at all. Or if they do test, they only test the inactive form (25-hydroxyvitamin D), and not the active form (1,25-dihydroxyvitamin D) – which I believe is incomplete – you need to be testing both of them.
In any case, long-term supplementation with Vitamin D alone, especially prescription-high-doses, can throw the other fat-soluble vitamins AND your minerals out of balance. I always recommend taking at LEAST Vitamin D & A together, and by Vitamin A I mean retinol, NOT beta-carotene, which is poorly converted, especially in autoimmune disease. Best case scenario, you’re eating a lot of A & D rich foods from your diet AND getting a decent amount from supplements – not a super high dose unless you’ve tested and know you need it – of ALL the fat soluble vitamins: A, D, E & K.
Vitamin D specifically is a very important regulator of the immune system, which of course is dysregulated in those with autoimmune diseases. We just don’t want to be super-dosing long term, without testing or taking into account the status of the rest of your vitamins and minerals!
Your body manufactures Vitamin D from the sun from cholesterol under your skin… So I always recommend that my clients get 20-30 minutes of sunlight daily if possible, but cholesterol, of course, we get from animal fats! The higher quality the animal fat, the higher quality the cholesterol, and the easier it is to make Vitamin D. (Fun facts: cholesterol is also an important component of our cell walls, sex hormones and stress hormones, and the majority of our brain is made up of cholesterol!) We can manufacture some cholesterol in our bodies, but again, if you have an autoimmune disease, you’re dealing with an impaired immune system and a dysregulated digestive system – you’re not going to be capable of making enough cholesterol to manufacture your stress hormones, sex hormones AND Vitamin D. You need to get it from your diet and be able to digest it.
Going back to getting this from food: when you’re eating animal products from healthy animals that are raised using humane, sustainable and regenerative agriculture methodology, you’re going to be getting superior nutrition. Let’s take, for instance, grass fed beef – a cow that is raised on organic grass is not only eating tons of beta carotene which converts into Vitamin A, and making healthy Vitamin D in its body, but it also has conjugated linoleic acid, which is incredibly important for building lean muscle and controlling weight gain. Grass fed-dairy (if you can tolerate it) also contains a lot of the fat-soluble vitamin K, which is very important for the health of your gut, bone, and teeth.
Now, I’m not suggesting you eat nothing but saturated animal fat – that can be problematic in itself. But around 10-15% of your caloric intake from saturated fat is a really healthy amount for most people. Also, if you can’t find super high quality meat where you live, or can’t afford it, it’s better to buy leaner cuts and then supplement with those vitamins!
B Vitamins are another group of vitamins that are important for autoimmune disease, as they have vital roles in the immune, detoxification, and energy production systems. But there are a few things to look out for when reading labels on your B-complexes – because not all Bs are created equal! You want to make sure you are getting the most bio-available, or absorbable, versions of each of these vitamins.
But B-Vitamins also have to be balanced with each other for optimal function. What often happens is that doctors will test just a one or two B-Vitamins in the blood, especially in patients that complain of fatigue (which is a super common issue for those with autoimmune, even if they haven’t been diagnosed yet). Then people start taking something like B-12, without a full B-complex supplement. OR they get B-12 shots, which are often not the most bio-available form. Generally it’s in the form of cyano-cobalamin, which I don’t recommend.
B-vitamins are tricky – we can get some from food, from fermented foods especially, and our healthy gut bacteria actually produce a lot of B-vitamins for us as a byproduct of digestion, but if you can’t tolerate fermented foods because you have gut dysfunction, SIBO, or histamine intolerance, and your gut is not healthy so you’re not manufacturing those B-vitamins, you definitely need to supplement. There are also some people who, genetically, just need more B-Vitamins than others!
So when you’re reading labels, what are those bio-available forms of B-Vitamins you need to be looking for?
For B-6, you want to look for the form called “P-5-P”, which stands for pyridoxal-5-phosphate, which is the active form used in the liver.
For B-9, or folate, please please please avoid folic acid. They are not the same thing – folate is the natural form of the vitamin, and folic acid is a synthetic form that over half the population does not convert well into the bio-available form of folate. This can lead to health issues which I’ll cover in a different post. But what you want to look for is folate from food, like broccoli, folinic acid, or possibly methylfolate – but read on to see why that’s not my first choice most of the time.
My favorite forms of B-12 are adenosyl-cobalamin and hydroxyl-cobalamin, because they are both easily absorbed, and the adenosyl version is the form used by our mitochondria (the energy-producing powerhouses inside our cells)! My second favorite is methylcobalamin, but anything with “methyl” in front of it can contribute to anxiety in people who are prone to it. Notice that I said “can” – it’s not a sure fire thing, but not everyone can tolerate a bunch of methylated B-Vitamins right off the bat – especially if their health is poor and they haven’t been taking high-quality supplements. So unless I’m working closely with someone and I know their genetics and their nutrition status, I don’t generally start with methyl B-12 or methylfolate.
The last couple words of caution that I have for you is, if you have a known food sensitivity; use your best judgement when taking vitamins that are sourced from whole food. For instance, if you have a known broccoli sensitivity, you may want to avoid folate from broccoli. (You and your practitioner can assess the risk vs. reward of taking a supplement that contains a food you are sensitive to, or one that is outside of the AIP protocol.)
Hopefully this was helpful for you! If you want to see if working with me to implement and personalize the autoimmune protocol is right for you, feel free to schedule a clarity call with me and we’ll chat it out!
In conclusion: don’t be afraid of supplements! We often need them – even if we eat a perfect, diverse, organic diet – our food is not as nutritious as it used to be due to the degradation of our soil quality. But do please use caution, remember you get what you pay for in a lot of these cases, and work with a skilled practitioner that you trust!!