Health Information

Feed Your Health Well

During the month of March, we recognize National Nutrition Month. It’s a time for everyone to become more informed about the value of developing healthy eating habits.

Because so many members of our patient communities live with autoimmune diseases, we are especially concerned about how certain foods promote inflammation in the body. Foods that are highly processed, such as high-salt ready-to-eat meals, sugary cereals, high-fat processed meats, and sodas made with high fructose corn syrup are among the products nutrition counselors caution against.

If you’ve thought about how the foods you eat might be affecting your health, this might be the month when you experiment with trying something new. You can use the following ideas as guidelines for making wise food choices.

  • Avoid processed and fast foods, including those with high fructose corn syrup, artificial ingredients, preservatives, and pesticides. Instead, opt for fresh food. Eat a variety of brightly colored fruits and vegetables and foods that don’t contain a long list of unpronounceable ingredients.
  • Reduce the number of foods made with refined white flour and sugar, especially bread, pasta, and most packaged snack foods. Instead, choose foods made with whole grains, such as brown rice, bulgur, and quinoa.
  • Try to eat less saturated fat by cutting back on animal products and foods made with palm kernel oil. This will help your heart as well as your immune system.
  • Use extra-virgin olive oil and expeller-pressed canola, sunflower, and safflower oils.
  • Experiment with adding avocados and nuts to your diet, especially walnuts, cashews, almonds, and nut butters made from these nuts.
  • Eat more vegetable protein, especially from beans and soy, and choose fish, cheese, and yogurt more often than you choose meat.
  • Avoid drinking soda and choose tea instead of coffee.
  • If you drink alcohol, red wine may be preferable.
  • And here’s the good news: dark chocolate (in moderation), can be a healthy choice! (Choose the kind with a minimum of 70% cocoa.)

If you take corticosteroids (prednisone, for example), especially in high doses and for long periods of time, you may develop side effects that have implications for what you eat.

  • Prednisone increases appetite. To avoid weight gain, try to avoid high-calorie foods. Eating frequent, small meals can help maintain steady blood sugar levels so you don’t feel hungry. Getting plenty of exercise will also help.
  • To reduce the risks of high blood pressure and fluid retention, try to keep your salt intake at less than 1,500 mg per day. You can do this by eating fresh rather than processed or canned foods and hiding the saltshaker.
  • If you take medication for high blood pressure, you may need to eat foods high in potassium, such as bananas, apricots, cantaloupe, baked potatoes, and tomatoes.
  • Prednisone can irritate the stomach, so it is important to take it with food, not on an empty stomach.
  • Diabetes is also a risk when taking steroids. To keep blood sugar levels within the normal range, avoid foods high in simple sugars, such as fruit juice and those gooey pastries, and keep carbohydrate intake to between 45 and 60mg per day.

It may not be possible to get all the nutrients you need to be healthy from your diet. That’s where eating specific foods or taking supplements may be useful. The following suggestions are recommended for those who have autoimmune diseases.

  • Bone health is a concern for those who take prednisone. That’s why it’s important to eat foods rich in calcium, such as milk, yogurt, cheese, leafy green vegetables (kale, bok choy), almonds, and broccoli. Calcium supplements may also be needed to minimize bone loss and osteoporosis.
  • Vitamin D is a hormone produced in the skin in response to sunlight. It is also important for bone health as well as controlling inflammation. Because most people do not (and probably should not) spend enough time in the sun, most people need to take Vitamin D as a supplement.
  • Folic acid (also called folate) is a B vitamin that is found in leafy green vegetables, such as spinach, kale, broccoli, and other foods. Because the drug methotrexate interferes with the way folic acid is used in the body, if you take this anti-inflammatory medication, you may need more folic acid than you can get from food. You may want to ask your doctor about folic acid supplements.
  • Omega-3 fatty acids, which are anti-inflammatory, and omega-6 fatty acids, which cause more inflammation, should be in balance in the body to keep us healthy. Most Americans, however, eat much more omega-6 (found in vegetable oils, safflower oils, meat, poultry, and eggs), which causes a more pro-inflammatory state. Eating more foods containing omega-3 fatty acids, such as salmon, mackerel, sardines, leafy green vegetables, flaxseed, canola oil, walnuts, and enriched eggs, can help bring this back into balance. Omega-3 supplements are also available.

Of course you should always avoid foods that you are allergic to. And as always, it’s important to discuss diet with your healthcare providers to be sure they know that you are concerned about this important lifestyle habit and can guide you in making the best choices.

Health Information Patient communities

COVID Vaccine and Our Patient Communities

Across the country we are starting to see the light at the end of the tunnel as the rollout of COVID-19 vaccines has begun. For many of our patients with primary immunodeficiency diseases or autoimmune conditions, however, getting vaccinated is not a straightforward decision. They have lots of questions and must weigh carefully a number of considerations.

Immunologist and rheumatologist Dr. Terry Harville has some concerns, too. “There are questions in my mind that haven’t been fully answered,” he says about the new vaccines that have recently been granted emergency use authorization by the Food and Drug Administration (FDA). “And I’m worried that there will be unintended consequences.”

The fact that we have only two months’ worth of safety data from the clinical trials testing these new vaccines from Pfizer/BioNTech and Moderna leaves many medical professionals worried about longer-term effects. Others are unsure about how the vaccines will react in patients with rare autoimmune and primary immunodeficiency diseases, because testing did not include people who live with these conditions.

Despite these concerns, Dr. Harville—along with most other healthcare practitioners—stresses that most people should still get the vaccine. Because when hundreds of thousands of people get COVID and one or two percent of them die, the statistics overwhelmingly support COVID-19 vaccination.

Dr. Harville, who is a professor of medicine at the University of Arkansas for Medical Sciences and an expert in primary immunodeficiency disorders, offers some guidelines for those who are trying to make a decision about the vaccine and might be at greater risk for complications from it.

If you have a primary immunodeficiency (PI) disease, you probably already know that you need to be careful about taking immunizations, especially if they are made with live virus. The COVID-19 vaccines that are currently being administered, however, are not made with live virus. They are created from a man-made part of the virus’s genetic code called mRNA. This means they are safer for those who are unable to take live virus vaccines.

With a few exceptions, Dr. Harville says, “It is the general consensus that we don’t see any reason to not vaccinate those with primary immune deficiency diseases.”

One exception is interferonopathies, IDs associated with dysfunction in components of the immune system called interferons. Another exception is CTLA4 deficiency. These are conditions in which patients tend to develop autoimmune disorders. Dr. Harville recommends that individuals with these types of ID should probably not get the currently available COVID vaccines. While there is no data to support this at this time, there is concern among immunologists that vaccination in this group of patients may trigger an overly aggressive immune response that would be harmful. As more data becomes available, better recommendations will be forthcoming.

If you use immune globulin therapy, there appears to be no reason you shouldn’t get the vaccine. In fact, even if you get the disease, you may actually be better off than others.

“What’s interesting is,” Dr. Harville says, “if you look at SARS-CoV-2 infection in patients with antibody deficiencies—whether that’s X-linked agammaglobulinemia (XLA) or common variable immunodeficiency (CVID)—when these patients are receiving appropriate immunoglobulin (IG) replacement therapy, they tend to have milder disease.”

Intravenous immunoglobulin (IVIG) has even been used, in some cases, to treat COVID-19 infection. While clinical trials to prove effectiveness are still ongoing, some physicians believe IVIG does decrease the risk of severe complications. IG manufactured from the plasma of people who have recovered from COVID-19 infection is also being tested as a treatment.

If you have had a severe reaction to immunizations in the past, this may be a reason to opt out of getting the COVID vaccine. This includes those who have a primary immunodeficiency disorder and developed the infection after receiving a vaccine. It also includes autoimmune disease patients who have experienced a severe flare of their symptoms after a vaccination.

In the 1976, there was a rise in cases of the autoimmune condition known as Guillain-Barré syndrome (GBS) that was thought to be triggered by the swine flu vaccine given that year. This was an inactivated virus vaccine, not the type of mRNA vaccine we now have with COVID. Nevertheless, if you’ve had GBS in the past, be sure to let your healthcare provider know this, as it may be a consideration for whether or not you should get the COVID vaccine.

During the COVID vaccine clinical trials, a very small number of participants who received the Pfizer vaccine developed a severe, life-threatening allergic reaction. Since then, others have also had what is called an anaphylactic response soon after getting vaccinated. If you have ever experienced shortness of breath, tightening in the throat, swollen lips or face, or other severe allergic symptoms, you should probably not get this vaccine in particular. (Other vaccines using whole virus are currently in development and will likely be safer.) Anyone who does get a COVID vaccine should be observed for at least 15 minutes and be sure the healthcare personnel administering it have emergency equipment needed to respond to anaphylaxis.

Regardless of your disease, everyone can reduce their own risk. Dr. Harville stresses that, even if you get vaccinated, it’s still important to wear a mask, wash your hands, and maintain physical distance from others.

“Ultimately whether you take or do not take the vaccine is an individual patient decision,” Dr. Harville says. “This should be made after weighing all the risks and benefits and based on a discussion with your physician.”

We highly recommend that you learn more about the risks and benefits of COVID-19 vaccination as it relates to your particular situation. The Centers for Disease Control and Prevention (CDC) offers these guidelines for COVID-19 vaccination for those with underlying medical conditions. In addition, a number of disease organizations offer educational programming about the impact of the virus and the vaccine on specific disease conditions.

Please also see disease-specific statements about COVID-19 vaccines from these patient organizations:

Guillain-Barré syndrome – GBS|CIDP Foundation

Immune Deficiency Foundation

Myasthenia Gravis Foundation of America

The Myositis Association

Myositis Support and Understanding

Platelet Disorder Support Association