My Notes From the Diabetes Summit
An Interview with Sarah Ballantyne PhD
I really feel as a whole the public has a greater capacity of understanding the scientific concepts behind disease and health than their ever given credit for. My main voice in the community is taking these scientific studies and distill them into actionable items for people without dumbing it down I really dislike dump truck analogies.
Autoimmune disease is a condition where the immune system whose roll is to protect us from foreign invaders viruses, bacteria, parasites, even a sliver that gets into our skin to protect us from the outside world. What makes an autoimmune disease is the immune system gets confused, it no longer has the capacity to differentiate between what is foreign and what is part of the human body. When the immune system gets stimulated it’s not just attacking a virus or a parasite but it’s attacking proteins within the human body. This effects cellular health that can eventually effect tissue health. When the damage from those attacks builds up that’s when you get symptoms and can get a diagnosis of an autoimmune disease. The difference between different autoimmune diseases is just exactly what protein is being targeted, what tissue is being attacked by the immune system. If it’s your thyroid being attacked you either get Graves or Hashimoto Thyroiditis. What is happening is a complex series of events that is causing the immune system to get overstimulated and confused at the same time and what cause that is not one thing. I think that’s one of the biggest frustrations not just for the scientific community that’s trying to understand all of the details of autoimmune disease but also the patient whose trying to figure out why do I have this, what did I do wrong, how can I manage it, the frustration is there is no one cause.
We know that genetics is a factor but it’s not one gene at risk, but it’s not a life sentence if you have these genes it doesn’t mean for sure your going to get an autoimmune disease there is a bunch of them. We know of a couple dozen genes that each one increases your risk, if you have more than one that increases your risk even more. We probably know maybe ten percent of the genes that are out there potentially increasing your risk of autoimmune disease so that makes it very complicated. We know that genetics is responsible for approximately between one quarter to one third of your risk the other two thirds comes from the environment. This includes toxin exposure, infections and that could be a history of infections that could be mono as a kid that could be a trigger. It could also be persistent infections like H-pylori that fifty percent of us don’t know we have, it could include diet there are foods in the typical western diet that are very inflammatory and can stimulate the immune system and know to be sources for the confusion that the immune system has. It could be lifestyle so when we are stressed, when were not getting enough sleep, when were too sedentary or when were overactive, both extremes of the activity range we know that directly impacts the way the immune system works and the way that the immune system is able to regulate itself.
Hormones for women that unfortunately can just be puberty but it can be pregnancy, it can also be hormone therapy such as birth control, it can be environmental hormones that we can be exposed to in pesticides and plastics. It’s this collection of things that all work together. The really big problem is that the immune system looses the ability to regulate itself. Something I think people don’t understand about autoimmune disease is that initial accident of the immune system creating that antibody not only targets some foreign invader a virus or bacteria or maybe a food sensitivity and it targets gluten or casein. That antibody will also so happen to bind to some protein in the human body it’s called cross reaction and when it binds to a protein that antibody is now classified as an auto-antibody which means it now attacks something that belongs to us rather than something from the outside world. That accident happens in everybody it’s just statistics, there is enough similarity between us and earthworms that sixty percent genetic similarity we just have proteins that are in common. If your making an antibody against a protein against a foreign invader there’s this chance that eventually it’s accidently going to recognize your cell. Our immune system has these fail safes these ways of detecting that there’s this cell making an antibody that’s actually attacking us instead of a foreign invader we need to deal with that cell, we either render that cell inert or we kill that cell. We have these ways of controlling when this happens making sure that it doesn’t turn into an autoimmune disease. What happens in autoimmune disease with variety of genetic factors, environment, diet and lack of nutrients the immune system needs to perform these functions. All of these things contribute to that fail safe failing, that’s when you really get the problems. That’s where diet and lifestyle become relevant, we start to have strategies for supporting immune system function and regulation.
There are certain genetics, certain gene variances that can influence, if you have a gene variant that renders your MTHFR enzyme less active that effects the methylation cycle that directly effects your bodies ability to detoxify, your immune regulation and sleep quality it effects everything. There’s so many proteins in our body that get turned on or off through methylation if you don’t have that cycle working properly then that’s a problem. That’s not something you would know if you just had a type 1 diabetes diagnosis or any other autoimmune diagnosis. That doesn’t automatically mean you have defects in methylation but having a defect in methylation is one of the things that can predispose you to autoimmune disease so it might be there. The only way to really know would be to do the genetic testing and that can be really instructive in terms of supplement, or I don’t think that genetic testing is the only way or the only important information. I think there is a lot of things that we can do without that expense to get that information but there’s definitely when your making changes and not seeing results that’s the next step is to look for if there’s something going on in terms of those systems. There are several variants of the human leukocyte antigen the HLA gene that predispose us to different autoimmune disease, there is a couple of variances that increase the risk of celiac disease and those are different from the one’s that cause rheumatoid arthritis. You can’t change that gene there is no nutritional strategies specific to supporting that system what it does is it effects how the immune cells that are like sentinels that go out and find things and then show the rest of the immune system that say’s it’s a bad guy were going to get this immune system response going and what that protein actually does is it effects how those cells present what they found to the rest of the immune system. When it’s working exactly right it changes how the immune system can detect any foreign invader and how it could respond to benign. As far as I’m aware there are no specific strategies for those different HLA variance but it does tell you if your kids are going to be at risk and maybe you want to be more proactive in terms of your kids diets and lifestyle factors. The environmental exposures you might have in your home, maybe that means your going to exercise, organic produce, more to avoid pesticides as a potential risk factor. In the case of a gene even though you don’t have something actionable that you can do yourself with that information there’s still some value in knowing and in terms of how your going to live the rest of your life.
Some autoimmune diseases happen because of a cumulative buildup of the onslaught onto the immune system over time from diet, lifestyle and environment. Some of it is pre-birth we know that what’s going on in the mother’s body has a profound effect on the fetus and we know that in terms of variety and circumstances. One of the major things that’s happening in autoimmune disease and were starting to get a bigger picture of it the roll that nutritional deficiencies play. As a whole the western diet is incredibly rich in calories and incredibly deficient in vital nutrients, vitamins, minerals, essential amino acids, essential fatty acids, we just don’t have the building blocks that our cells need to function optimally. We don’t have the basic raw materials for all the millions and billions of chemical reactions that are happening in every cell in every moment. We know that the immune system is an incredible nutrient hog, it is so greedy when it comes to nutrients. We know there are some really important nutrients that we tend to be extremely deficient in that are vital for immune system regulation. The immune system can be divided into two different functions the attacking function and the regulation function. It’s rarely easy to turn on the attacks and the body has to have a way to turn them off, there is a whole series of different ways that the immune system regulates itself. There are certain cells where it’s their job to keep everything under control. We know some really important nutrients like vitamin D which seventy five percent of us are deficient in, zinc eighty percent of us don’t get enough of in our diet, magnesium is really challenging to get from the modern food supply these are really important for immune system regulation. Amino acids like glycine which if you eat a typical chicken breast and hamburger your not getting enough glycine unless your eating a lot of seafood, organ meats or making homemade beef broth and glycine is phenomenally important for immune system regulation. Vitamin A the animal form of vitamin A it’s a retinoic acid we get from organ meat and seafood which our body can only convert about three percent of. The beta carotene were getting from a carrot into retinoic acid that’s important for immune system regulation.
There is this collection of nutrients that we know most of us are not getting to help regulate the immune system and the mother’s body if it’s deficient in those nutrients that means the growing fetus is going to be deficient in those nutrients. If you combine that with a genetic predisposition and if you combine that with foods the mother is having intolerance reactions to or combine with infections or with a microbiome that’s not working well to regulate the immune system or you have the wrong types of numbers or diversity. When you start to combine all these different factors that’s when you can have a baby born with an autoimmune disease, it’s frustrating because it’s so subtle there’s nothing overt you can point to. I don’t want these mother’s to blame themselves for having these children with type 1 diabetes because it’s not their fault, there’s nothing here that says you should have known better. There is so little education for what are the best types of foods to be consuming and there’s no way to test how healthy our gut bacteria are we don’t know what’s optimal yet. Part of it is understanding where we can modify what we are doing to decrease our chances of autoimmune disease and help regulate our immune system once we have developed it and accepting what we can’t change and not letting it defeat us. Don’t get stressed over it because that also effects how the immune system regulates.
There is a variety of hormones that are impacted by sugar intake that are immune modulators including insulin, insulin has a direct influence on how the immune system is functioning. It’s interesting because you end up suppressing the immune system, certain aspects of it, your over stimulating other aspects of it and suppressing the regulatory arm which is allowing the attacking arm to be over stimulated. Insulin is directly impacted by carbohydrate intake so is cortisol, thyroid hormones and a growing number of the hunger hormones leptin and grelin also impact this one not by carbohydrate intake but by the different ratios of nutrients we get. We know that fiber intake that helps regulate how quickly our blood sugars go up after a carbohydrate intake, fiber intake does a better job of suppressing grelin after we eat compared to other macronutrients. It’s not just a question of high carbohydrate intake part of the problem is high intake tends to come with other low important things intake. What’s common between type 1 and type 2 diabetes is the inflammation, both of these conditions the inflammatory cells are making chemicals called cytokines that stimulate the beta cells to commit cell suicide. Even in type 2 diabetes we think of it being an insulin resistant problem we know that the beta cells are dying off so you wind up with having the problem on both sides. Your cells are not responding to insulin as well but your also not making enough insulin, you have both sides of the coin. With type 1 diabetes it’s just the first side we know it’s inflammation in common, eating is inflammatory. I don’t want to just say that a high sugar diet is inflammatory eating anything is inflammatory it’s the downside of being complex organisms we use oxygen so therefore when we eat we have inflammation. We do know that high sugar diets are more inflammatory than other things we can be eating. We know insulin spikes as well as lows is one of the problems associated with too much insulin with both diabetic and non diabetic. Insulin highs and lows and blood sugar highs and lows impact how the immune system is functioning. There are pathways that are common with all chronic illness because of inflammation being part of the pathogenesis or the development of every chronic illness.
In terms of management strategies whether your type 2 diabetic and your just using a measured carbohydrate approach, using the standard American Diabetes Association that’s really helpful for type 1 diabetes. It helps with inflammation and can help regulate the immune system so you can actually preserve some beta cell function. There are anecdotal stories in the paleo community of people being able to decrease their insulin not just because their consuming fewer carbohydrates but because there’s actual cell production turning on. There are no clinical trials that validate that in a systemic way but anecdotal evidence is fairly compelling and from a mechanistic standpoint it makes sense. If you can reduce inflammation and regulate the immune system you can preserve what’s left of your organ function and potentially allow for healing it’s super exciting and it would be great to see that in a system randomized clinical trial.
Disease management is far more complicated than carbohydrates, we know that carbohydrates are influencing the immune system but there are far more compounds in the typical western diet that are stimulating the immune system impacting our gut. We know our gut health is really important for how the immune system is functioning both from the perspective of the barrier for the inside and outside world perspective, but also from the bacteria that it turns out are vital for our health. In terms of dietary strategies it’s much more complex than just measuring and reducing your carbohydrate intake. One thing we know is the value of adequate nutrition I mean lot’s of vitamins lot’s of minerals all the essential amino acids all twenty of them and essential fatty acids which means balancing omega 3 fats and omega 6 fats, that is in a huge amount of chronic illnesses. It’s really about maximizing nutrient intake and we do that by eating a lot of vegetables. Non starchy vegetables that are not going to impact blood sugar regulation and then measuring fruit and starchy vegetables that do have a more direct impact on blood sugar but tons of non starchy vegetables. We know consuming lot’s of fish, shellfish and sea vegetables like seaweed are huge nutrient powerhouses and consuming organ meats. We used to eat these a lot it’s the most nutrient dense part of the animals and organ meats tend to be the richest sources of the nutrients that are most important for immune regulation and for turning off inflammation. Having those as regular features in your diet make a difference and then there’s certain foods that are inherently inflammatory that are damaging the gut or feed the wrong bacteria in the gut which then can be inflammatory. Looking at a paleo template this has the majority of the inflammatory foods taken out and has focus on nutrient density and there’s lots of room for self experimentation.
Nightshade vegetables, tomatoes, eggplant, peppers, cayenne, tend to be very problematic with people with chronic health conditions because they contain some of the most potent adjuvant in our diet. Chemicals that are being investigated for use in vaccines because their so good at stimulating the immune system they tend to be in nightshades, also soy, peanuts, gluten and wheat. It’s not just about gluten it’s also about wheat germ and gluten which is probably more toxic in terms of how the immune system is functioning. If you have an autoimmune disease chances are these foods are not working for you. It’s not just about diet, there is a Paleo autoimmune protocol that is designed to maximize your chances of regulating the immune system through diet but their lifestyle factors are inflammatory. Not getting enough sleep is inflammatory, the main regulatory functions of the immune system are done while were sleeping if your not getting enough sleep your not regulating your immune system. We can measure the amount of inflammation in the blood after not getting enough sleep. If your not getting enough sleep during the week and then sleep in on the weekend we know there are certain aspects of the immune system that are really important in autoimmune disease that stay stimulated even after sleeping all you want on the weekend. It’s about consistently getting enough sleep. Society as a whole we get one and half to two hours less sleep than we did fifty years ago. I did the math it’s about a month of continuous sleep per year we used to get and we vitally need. It’s far more likely lack of sleep and how far more stressful our lives are has far more to do with the increased risk of diabetes, obesity, metabolic syndrome and cardiovascular disease than any changes to our food system. These things are really important regulators to our immune system of our hormones of our brains ability to detoxify. As our brain is just thinking and doing stuff during the day it’s metabolizing energy it’s producing waste products. The waste products build up during the day and when we sleep the cells in our brain shrink slightly, this increases the circulation between the cells to flush those toxins out if you don’t get enough sleep your building up toxins in your brain.
Stress has a high impact on the immune system it cannot be underestimated how important it is to not just reduce stress but also increasing resilience to stress which means having fun, being outside in nature, seeing the sun daily would be good, meditating learning how to shut your brain off letting everything go. There is a huge body of scientific literature showing the amazing therapeutic potential of meditation for immune system regulation for chronic health conditions. Being active we know that sitting for a long period of time being sedentary definitely suppresses the immune system and increases our risk of chronic illness. We also know that being overactive and engaging in really intense strenuous especially prolonged activities is also really hard on the immune system. This is happening a lot today in society with the way things are structured, people are sedentary eight hours a day at work then go to the gym and do an intense workout your getting both of these problems, try to find a way to do light activity through the day. Every thirty minutes get up and stretch, walk if you can just keep your body in motion through the day and taking it a little easier at the gym at night.
As powerful as the dietary strategies are the lifestyle ones are harder for us to do, it’s harder for us to turn off everything and go to bed an hour earlier than we do. Lifestyle strategies are more unique solutions for peoples lives because all of our lives are structured differently and they really require commitment and problem solving to figure out how am I going to get eight hours of sleep every single night. How am I going to fit in ten minutes of meditation in my day and how am I going to avoid sitting for eight hours straight those things are just as important as diet and requires more effort.
I have a Paleo cooking show coming out on network T.V., a pilot, the information is on my web page.
Sarah Ballantyne PhD web page thepaleomom
Disclaimer: The information contained on this site is for educational purposes only and should not be used as a substitute for diagnosis or treatment rendered by a licensed physician. It is essential that you discuss with your doctor any symptoms or medical problems that you may be experiencing.
M. Scherker medical researcher