My Experience with the AIP to Treat Lichen Planus

May 26, 2012 in Sarah's Personal AI Struggles, Specific Autoimmune Diseases

Many of you have expressed your frustration that you are not seeing improvement in your autoimmune disease despite following the Autoimmune Protocol.  I have tried to give you a realistic timeframe for how long healing may take to help you find some patience with the process.  I also thought that recounting my own experience with the Autoimmnue Protocol may be helpful for you. 

As I reflect on the health conditions I suffered from in my early-twenties to early-thirties, what once seemed like disparate conditions suffered by a genetically weak me, I now clearly see as the linear progression of inflammation and autoimmune disease resulting from a gradually worsening leaky gut, developing adrenal fatigue and developing metabolic syndrome.  Rather than being the result of weak genetics, I now see it as the result of poor diet, extreme stress, and a misguided exercise routine.  My chief autoimmune complaint is a skin condition called lichen planus.  Purple-red, ridiculously itchy to the point of painful lesions in the mucosal layer of my skin appear predominantly on my ankles and wrists, but also on my shins, forearms and even torso.  Although I have never been tested, it is likely that I have lesions in internal mucosal tissues as well, namely the gut mucosa.  If this is the case, this means that my leaky gut has caused inflammatory lesions in my gut which would make my gut leakier, definitely a vicious cycle.

I have had lichen planus lesions for a little over 10 years.  Many (but not all) of them disappeared while I was pregnant (autoimmunity is suppressed during pregnancy) and nursing (and I was pregnant or nursing for 5¾ years straight), but they returned with a vengeance last summer when my youngest daughter night-weaned and suddenly went from nursing 12 times per day to only once or twice per day (this doctor-ordered forced night weaning is a topic for a future post).  They got even worse in December when my daughter weaned completely (self-weaned, phew!).  The standard treatment is potent steroid creams applied 2-4 times per day.  Stubborn lesions can be injected with steroids and oral steroids are always an option.  No doctor ever mentioned that this was an autoimmune condition (and I had 5 different PCPs in 5 different cities during this time). 

Researching solutions for my lichen planus brought me to paleo.  The dramatic improvement I saw to other health conditions inspired me to start this blog.  Performing research for this blog brought me to the realization that I had an autoimmune disease and that I should be following the Autoimmune Protocol.  I can’t tell you how thankful I am to all of you for your part in this discovery.  I am optimistic that I have finally figured out what foods and other lifestyle factors my body needs to be healthy, and that is some very powerful knowledge.  Unfortunately, I suspect that I will never be able to eat eggs, almonds, or tomatoes again.  I do seem to handle the occasional egg yolk, small amounts of spices that are ground seeds, small amounts of paprika which is from the nightshade family but is quite low in capsaicin, the occasional square of dark chocolate as long as it doesn’t contain soy lecithin, and the occasional dose of macadamia nuts which are low in phytic acid and polyunsaturated fats.

I started the autoimmune protocol at the beginning of January, with frequent slips in my resolve over the first few months (gradually getting better at really following the Autoimmune Protocol). It’s hard to be surrounded by tasty paleo baking, even feeling compelled to continue experimenting with recipes using ingredients I can’t eat.  But even though I was struggling with compliance, I did see some improvement in my lichen planus lesions, albeit small and extremely slow.  I also watched my weight creep up.  I’m not sure if my weight creeping up was a result of not getting enough sleep during this time, mostly not eating breakfast during this time, or eating too much fat and not enough protein during this time—but I suspect that allowing myself to gain some weight was critical in also providing my body with the energy and micronutrients required to heal.  And as I got better and better at avoiding eggs, nuts, seeds, and nightshades, I noticed more easily the negative effects when I did eat them.  My lichen planus became an excellent litmus for foods I can’t handle.  These obvious reactions made it easier to avoid those foods.  And as time as past, I have found more foods to eat and stopped skipping meals because I simply couldn’t think of what to make. 

The last 3 weeks have seen an absolutely profound improvement to my lichen planus.  Other than the one lesion on my ankle that has been there the most consistently and for the longest time, which now looks like a scar (actually, it might be a scar!), you wouldn’t notice anything amiss about my ankles, wrists, shins or forearms (unless you were looking really closely, but that would be weird think for you to do!).  I can still see the dry, inflamed skin that still needs to heal.  It’s not all the way there, but it’s such an amazing difference (all with no steroids too!) that I finally have that confidence that I am eating the right way.  Oh, and my weight has started dropping again too.  It could be that I’m sleeping better, eating breakfast, and eating more protein.  But I think that reducing the inflammation in my body, which is allowing my hormones to normalize, is a critical component of this weight loss (the real test will be if my weight drops below my lightest, which is only 2 pounds away now).  I should have taken a “before” photo, but who wants to document their ugly ankles?  This is a current photo of my ankle though (I literally just took it!):

 My husband was shocked at how great my ankles look when I pointed it out to him about a week ago.  If you want to see what my lichen planus looked like before, you can check out this online pamphlet from the American Academy of Dermatology  (the front photo looks like my smaller lesions; I had many lesions that were ½” in diameter and even one that was over 1”). 

What has changed in the last 3 weeks to account for this sudden improvement?  There are a couple of other things that I think have really helped, beyond finally getting to 100% compliance with the Autoimmune Protocol.  First, I started getting alot more sun exposure.  I try and always at least roll up my pant legs to my shins and wear a tank top.  I try and go outside with my kids at least 30 minutes per day.  The beach trip for Mother’s Day weekend gave me LOTS more sun exposure than normal.  Our neighborhood pool is now open and I am bringing the kids for a swim at least twice per week.  And I am still taking 10,000IU of Vitamin D3 a day (which my doctor thinks is extreme).  I am eating alot of organ meat, especially beef heart which is rich in collagen (which means rich in proline and glycine, those amino acids that are so vital for healing skin and connective tissues).  I eat organ meat for at least one meal every day.  I am drinking more bone broth (1 cup most days).  I am mostly eating grass-fed meat and wild-caught fish (still some conventional poultry and pork in my diet, but I’m doing my best with my budget).  I have stopped sprinting for now, thinking that it might have been too much stress on my body, but I am still walking, playing with my kids, and going to 3 yoga classes per week. 

Was it all these tweaks that made everything come together for me?  Maybe, but I also think that those 4 months of not seeing much improvement were actually important.  I suspect that, during those 4 months, my gut was healing, my body was gradually decreasing antibody production, and inflammation was resolving.  I think it took that time for my insides to heal to a point where I could see improvement on the outside.  As an aside, I have noticed that my mood has been noticeably better these last few weeks too (more vitamin D or less inflammation in my brain or both?).  The Autoimmune Protocol is working for me.  But it’s tough and it’s slow.  So, when I advocate patience, know that it comes from experience.

You May Have an Autoimmune Disease But Don’t Know It!

May 12, 2012 in Specific Autoimmune Diseases, The Autoimmune Protocol

Do you have an autoimmune disease that you are unaware of?  I’m not talking about the severe autoimmune diseases like lupus, multiple sclerosis, non-Hodgkin’s lymphoma, and Grave’s Disease.  If you are unfortunate enough to suffer from one of these types of conditions, you are probably already aware that they are autoimmune in nature.  I’m talking about the conditions which are generally not life-threatening (although some of them can become so), for which the treatment may be as simple as a small dose of steroids or daily NSAIDS, and for which doctor’s typically shrug their shoulders like it’s no big deal.  Yes, a surprising number of those types of conditions, eczema and arthritis for example, are actually autoimmune in nature.

As I perused a list of confirmed and suspected autoimmune diseases, I was shocked by how many common skin conditions and gut health disorders are autoimmune in nature (to the point where I wonder if all digestive disorders and skin conditions will eventually be considered autoimmune diseases).  I was also surprised by how many autoimmune diseases are characterized by nebulous symptoms that could easily be ignored and attributed to not getting enough sleep (at least until they get bad enough).  Wikipedia has a comprehensive list of autoimmune diseases (here’s the link), but here are some that stood out to me as ones that many people suffer from without ever being told that they are actually autoimmune diseases (some of these are suspected autoimmune diseases rather than confirmed and some of them are certainly life-threatening serious diseases but maybe not commonly understood to be autoimmune in nature).

  • Alpopecia (spot baldness)
  • Arthritis (all forms)
  • Atopic Allergy (tendency to be hyperallergic)
  • Dermatitis (all forms)
  • Cancer
  • Type I Diabetes
  • Eczema
  • Endometriosis
  • Gastritis
  • Lichen Planus
  • Lichen Sclerosis
  • Morphea (localized scleroderma)
  • Myositis
  • Chronic Fatigue Syndrome
  • Narcolepsy
  • Polymyalgia rhematica
  • Psoriasis
  • Restless Leg Syndrome
  • Schizophrenia
  • Scleroderma
  • Vasculitis

It is worthy to note here that there is a whole other group of diseases, such as anxiety and depression, asthma, allergies, Type II Diabetes and even acne, that are not considered autoimmune disease but for which the immune system still plays a part.  If you suffer from any of these conditions, it is worth while giving strong consideration to following the paleo diet Autoimmunie Protocol, especially if out-of-the-box paleo doesn’t address your health issues. 

The more I read about health and nutrition, the more I am coming to believe that autoimmunity acquired as a result of a leaky gut caused by the Standard American Diet is far more rampant than epidemiological reports would have us believe.  I suspect that autoimmunity is a spectrum with symptoms so mild in the early phases that we are generally unaware.  I suspect that autoimmunity is very common is people with metabolic syndrome (or even people who simply struggle with weight loss).  And I think that in many people those ethereal early phases of autoimmunity can last years or even decades.  The symptoms of autoimmune conditions can be nebulous.  They can come and go and not seem to be anything more than the result of the stresses of normal life and what we consider to be a normal part of aging.  But if you find yourself claiming that “I’m just not getting enough sleep these days” or “yeah, my knees have been bugging me” or “well, my mom had arthritis at my age”, take a hard look at these symptoms and consider the possibility that you are perhaps dealing with the very beginnings of autoimmunity. 

Symptoms which may be caused by autoimmunity:

  • Extreme Fatigue
  • Muscle and Joint Pain
  • Muscle Weakness
  • Swollen Glans
  • Susceptibility to Infections
  • Sleep Disturbances
  • Unexplained Weight Changes
  • Resistance to Weight Loss
  • Yeast Infections
  • Digestive Problems
  • Anxiety and Depression
  • Migraines
  • Recurrent Headaches
  • Memory Problems
  • Allergies
  • Rashes
  • Blood Pressure Changes (usually low)
  • Low Blood Sugar
  • Thyroid Problems
  • PMS

When dealing with these early symptoms of autoimmunity, you are unlikely to get a clear diagnosis from your doctor.  But, you are more likely to see rapid resolution of your symptoms by following The Autoimmune Protocol (you may even see resolution of your symptoms with out-of-the-box paleo).  And on the very bright side, if you “catch it early”, you may be able to eventually reintroduce nuts, seeds, eggs, nightshades and alcohol.  So, are you a person who needs to follow The Autoimmune Protocol?  Maybe.  I would make this suggestion:  if you don’t feel amazing after a couple of months on out-of-the-box paleo, try The Autoimmune Protocol.  It just might be right for you.

Modifying Paleo to Treat Psoriasis

April 19, 2012 in Sarah's Personal AI Struggles, Specific Autoimmune Diseases

In the paleo community, we are accustomed to assuming that a standard paleo diet will cure (or at least significantly improve) virtually every health problem.  But, if you have psoriasis (or dermatitis or eczema), be prepared:  paleo not only may fail to resolve these skin conditions, it might even make it worse.  Now, don’t go running for the hills.  The principles behind the paleo diet are still sound.  It is still the best way to eat for your long-term health.  And there are certainly some people who find complete resolution of their psoriasis symptoms with the switch to a paleo diet (for those people, the root cause of the psoriasis is typically a gluten sensitivity).  For me (and for many others), switching to paleo made my psoriasis worse.  This isn’t because paleo has us on the wrong track; it’s simply because out-of-the-box paleo is not actually enough. 

I am a long term sufferer of lichen planus, a form of psoriasis where the inflammation occurs in the mucosal layer of the skin (and very unnerving, you can actually get lesions in the gut mucosa as well!).  In fact, it was my search for a cause (and hopefully cure) for this condition that brought me to paleo in the first place!  All my other health issues either completely resolved or improved substantially within weeks of switching to a paleo diet, but my lichen planus did not improve.  If anything, it got worse.  But since paleo was working so well for me in every other respect, my search for a solution stayed within a paleo framework. 

What you might not know (and certainly I didn’t) was that psoriasis (and dermatitis and eczema) is an autoimmune disease.  It’s not always listed in those lists of autoimmune diseases that can be put into full remission by a paleo diet (it is listed in The Paleo Answer, but not The Paleo Diet nor The Paleo Solution).  Why is it so often left out?  I guess it’s because when compared to Lupus, Multiple Sclerosis or Non-Hodgkin’s lymphoma, psoriasis is small potatoes.  And let’s just take a moment to appreciate how lucky we are that, when our bodies formed antibodies against our own cells, we only ended up with psoriasis! 

Psoriasis is also an indicator of a severely leaky gut (that’s how we develop the autoimmunity in the first place), with a very high likelihood of Small Intestinal Bacterial Overgrowth.  It is also very commonly linked to a gut-brain connection problem with inflammation and autoimmunity targeting skin cells.  I went into some details about the gut-brain connection in this post, but I also recommend listening to the explanation of the gut-brain-skin axis that Chris Kresser gives in his Revolution Health Radio podcast episode titled “Naturally Get Rid Of Acne By Fixing Your Gut”.  There is a complex interplay between a leaky gut, a stressed body, loss of insulin and leptin sensitivity, mood issues, food sensitivities, and the inflammation that manifests as psoriasis.  Basically, if you suffer psoriasis, chances are your gut, your immune system and your hormones are all really messed up.  

So, what do you do about psoriasis?  The first and most important step is to follow the paleo diet “autoimmunity protocol”.  This means that in addition to all of the foods we already avoid while eating paleo, we must also avoid:

  • Eggs (especially the whites)
  • Nuts and Seeds (or at least severely restrict quantities)
  • Nightshades (tomatoes, eggplant, peppers of all kinds)

We are also people who Can Not CheatEver.  We can not tolerate any dairy, not even grass-fed butter or ghee.  Food quality becomes extremely important, so the more we can eat grass-fed meat, wild-caught fish, pastured eggs and chicken, and organic vegetables, the better (I know it’s expensive and I certainly can’t afford this 100%, but I just do the best I can).  And we are people who can’t tolerate very much sugar (even the sugars in fruits) or starches (even from superfoods like sweet potatoes) as they tend to feed the organisms in Small Intestinal Bacterial Overgrowth.  It would be worthwhile to have a look at the GAPS diet food list as an indicator of which fruits and vegetables should be avoided (although I wouldn’t suggest starting with the GAPS diet protocol unless you really have tried everything else).  And that’s not all.  Because stress hormones can play a key role in the perpetuation of psoriasis, it is especially important for us to get lots and lots of high quality sleep, avoid excessive caffeine intake (or cut it out completely), severely limit alcohol consumption (or avoid it completely), get lots of low-strain exercise, manage the stress in our lives, get sun exposure and take a Vitamin D3 supplement (on the higher dose side; I take 12,000IU per day in addition to trying to get outside every day).  I also suggest reading my recommendations on Repairing The Gut.  In particular, I suggest incorporating organ meat into your diet at least twice per week, consuming bone broth or other collagen-rich foods (like gelatin, stew hens and heart meat) at least twice per week (every day would be even better), consuming fermented foods (like raw Sauerkraut or coconut milk kefir) every day, and consuming coconut oil every day (I like it in my coffee). 

So how long until you see some results?  You should start to see improvement very quickly, within a couple of days for some people up to 3-4 weeks for others.  If you do not see improvement within a month, you may also have developed additional food sensitivities (your gut is leaky, after all).  If doing all of the above still isn’t enough to see improvement in your symptoms, it would be worth finding a physician, naturopathic doctor, or chiropractor who will order an IgG and IgA food sensitivity blood test (you might also investigate Small Intestinal Bacterial Overgrowth, internal yeast infections and parasite infections as possible confounding factors as well).  These food sensitivities are transient and once your gut has healed (and at least 6 months have passed without exposure), you should be able to reintroduce the foods.  Actually, you should be able to reintroduce eggs, nuts and seeds, higher sugar fruits and vegetables and maybe even nightshades at some point in the future as well.  Are you wondering how long this is going to take?  I’m afraid the answer is anywhere between 2 months and 2 years, depending on exactly what the root causes are for you.  But, if you could see how much my lichen planus has improved in 3½ months, you would be amazed.  I know that the extra dietary restrictions are tough, but it is worth it to be able to cure such an aggravating condition without the use of steroids.  And the thing to keep in mind is that once the psoriasis is gone, out-of-the-box paleo really will be enough for us.