00:00
Hey everyone, it's Mikki here. You're listening to Mikkipedia and this week on the podcast I'm stoked to be chatting to my friend Julianne Taylor. Julianne is a registered nutritionist, a PhD candidate and a returning guest to the show whose research is diving into one of the more complex and contested areas of nutrition science. And that's the role of managing rheumatoid arthritis through diet.

00:29
Julianne recently led a scoping review that sheds much needed light on the challenges and the promise of using elimination and reintroduction diets for people with RA. In this conversation, Julianne and I explore the broader aims of her research, what drew her into this niche in the first place. We unpack the motivations behind the review, including the striking lack of standardized protocols.

00:54
the limitations of popular food sensitivity tests, and the idiosyncratic ways people seem to react to foods. Julian shares her insights on why dietary interventions remain underutilized in conventional care, despite strong patient interest in some compelling mechanistic leads, ranging from fasting and gut permeability to mast cells and your immune crosstalk. We also talk about the impact of placebo and nocebo responses, the confounding effect of ultra-processed food removal,

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and where future research should focus. If you've ever wondered why diet and autoimmunity remain such a grey area, or what it would take to turn that grey into actionable science, this is an episode for you. For those of you unfamiliar with Julianne, she's been on the podcast before, episode 96, talking about her own journey from, I don't know, general shenanigans as a youngster, to all of her different career choices, to landing into nutrition, and now she's obviously as

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discussed a PhD candidate and she's also a very proficient power lifter and holds New Zealand records even. Julianne experienced firsthand the difference diet makes for herself. She experimented with the popular zone diet in the 90s and within days experienced increased energy, improved mental focus and excellent appetite control leading to weight loss without hunger. Further experiments led her to trying the paleo diet in 2009

02:19
which eliminated autoimmune joint inflammation and menstrual issues for her. As a result, she changed careers from a designer to a nutritionist and went back to university to study nutrition at Massey. In 2015, Juliane completed a postgraduate diploma in nutrition science and is now, obviously, undertaking a PhD. She has been researching the connection between diet and health since 97 and applying what she has learned to her clients with great success.

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She has a special interest in how diet controls appetite regulation by control of hunger hormones. And using these principles, she has helped hundreds of people lose weight with ease. We chat about Julianne's master's and PhD research in today's conversation. And she is currently doing her PhD research on the topic of dietary strategies for rheumatoid arthritis, which includes an intervention pilot study on the effect of autoimmune protocol diet on rheumatoid arthritis.

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Her current hobby is powerlifting and she represented New Zealand in Sweden in 2019 in the Masters III, 52kg category, winning a bronze medal for bench and she's going back to Worlds this year as well. I cannot wait to see how she does. So I have got links to where you can find Julianne on the internet, the previous podcast interview I had, which was much more about her and less about her research, a YouTube clip that we discussed.

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that she did for Arthritis New Zealand. Really great if you want some in-depth information and also the paper that we do discuss in depth here as well. So I've got links to all of these in the show notes. Before you crack on into the conversation though, I would like to remind you that the best way to support this podcast is to hit the subscribe button on your favorite podcast listening platform and share it with a friend. Both of these things help

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increase the visibility of the podcast in the amongst literally thousands of other podcasts that people could be and are listening to. So more people get to hear from the experts that I have on the show like Julianne Taylor. All right team, enjoy this conversation. Hey Julianne, thank you so much for taking time out of your day to come chat to me today. Of course,

04:29
people who have listened to Micopedia since its inception, which is of course, there's almost everybody and they're getting all their mates listen to it as well because it is that good, would recognize that you've previously been on chatting about probably more about your own professional and personal journey in the nutrition space. And I believe at the time that you came to chat to me, you were just embarking on a PhD at that time, or you were in the throes of

04:59
really sort of deciding what your research topic actually was going to be. I I was right at the beginning. Gosh, I can't remember when it was. I think I was right at the beginning, maybe changing from the MPhil to the PhD and something around that or the proposal or doing the small pilot study or, yeah, the early days. that's right. It was. And of course, what we will do is pop

05:25
our previous conversation in the show notes for people to understand, potentially go back and listen if they're unfamiliar with you and your work. And we probably touched a little bit on your study, but I was super excited when you published in our nutrition group that you'd just published your paper on rheumatoid arthritis and nutritional protocols and things like that. So I thought it would be an excellent time for us to

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just have a conversation about your PhD broadly, but then also some of the specifics of this paper and also how this sort of pertains to clinical practice, which is probably the most important part of it. Yeah, absolutely. Yeah, nice one. So can you just start with telling us about your PhD project and actually what drew you to the topic of rheumatoid arthritis?

06:23
So this goes right back to 10 years ago when I was doing my post-grad dip at Massey in nutrition. And it was not long after the kind of paleo movement started and I got very involved in that. I tried a paleo, this is like before even this, during my PG dip, I tried a

06:52
Paleo diet and my own joint inflammation, is probably autoimmune related because my mother has lupus and I have the same symptoms as her, which is just some joint inflammation and swollen knees and things like that. It just completely went away in three weeks and I had a ganglion cyst that disappeared off my wrist and I was quite stunned. And so when I was doing my PG dip, I decided in my last

07:22
section I would do a little qualitative study because I'd heard about some people who had done a paleo style diet either AIP or the immune protocol or just a normal paleo style diet and I think about three people and they had rheumatoid arthritis. So I interviewed those three and then I decided to do a bigger study for my last 60 credits.

07:51
I got 10 people, actually from around the world, I just put out notes on Facebook groups, and 10 people with rheumatoid arthritis, clinically proven, had all the measures to say that they had it. And they'd all got relief using a paleo diet. So I interviewed them, there was 10 people in that study. I wrote all that up, if anybody wants it, they're welcome to have a copy.

08:19
So I interviewed them and they talked about how the elimination style diet really just decreases symptoms. So I thought then that's great, but anecdotally, they're people who had success on this diet. That doesn't mean that everybody is going to. So, you know, it's just a case series really, case, a lot of case studies. So then I thought, okay, well, what really needs to be done is we need to do a proper clinical study.

08:49
to test it in a number of people with rheumatoid arthritis and see what the outcome is. And as nothing had been done at that point, I looked at doing a, what shall we say, pilot study and a feasibility study to see how it ended up with, and it ended up with nine people doing four weeks.

09:19
into four weeks on the habitual diet and then eight weeks on the AIP diet and I stream the same weekly measures throughout the whole study. Okay. Can I... So that's where it started. Okay. And can I actually just ask you about that as well? Because I know people, I mean, people are, I imagine, familiar with the Paleo diet. They may or may not have understood or know the sort of intricacies of the autoimmune protocol. So can you just...

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or for the purposes of this, us what is a paleo diet and what it excludes or both includes. And then also, what about AIP? So what is that? So yeah, the paleo diet is thinking kind of ancestrally back to our hunter gatherer days when what we ate was we evolved on the diet in our environment.

10:17
And basically, if you think you can gather it, it's fresh food. If you can kill it, that's fresh meat or seafood or gather shellfish or whatever. That's what the paleo diet is at its basis. And it's also pre-agricultural. So about 10,000 years ago, we started collecting seeds from cereal grains and growing them en masse. And at that point in time, our diet expanded rapidly.

10:45
in terms of incorporating grains and certain agricultural products, domesticating animals and collecting their milk. So it's kind of a pre-agricultural diet. And the theory is that human beings in some form or other have been around for over million years, and we evolved primarily on a hunter-gatherer style diet. So that would be best for our kind of physiology, I guess. Yeah, nice. And then how does an AIP diet

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differ from a paleo diet? Yeah, so Cordane hypothesized that there were modern foods that interacted in a negative way in terms of our gut, like a gut epithelium, and helping us or either causing sort of inflammation or increased intestinal permeability.

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or in some way being antigenic. So that means that we react to certain things like a foreign body. And some of those foreign proteins cross over into our bloodstream, and we react to those. in the course of reacting to those, we react to similar proteins in our own body. And that is a possible basis for autoimmune issues.

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So he hypothesized that if we removed foods that showed this sort of potentially antigenic gut inflammatory component, that we would possibly be able to remove the antigens that we were. It's called molecular mimicry, so they mimic what happened with the proteins in our own body. We react to those in our diet.

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And then we react to ones in our own body, if that makes sense. So we remove those. So he suggested that a whole series, because of chemicals or how they interacted with the gut, if we remove those, then we decrease this intestinal permeability. And then we had a chance to just stop or bring down the autoimmune antigens.

13:10
Yeah, so if we think about the foods that he said, he talks about things like gluten in cereal grains, glycoalkaloids in nightshades.

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casein and milk and egg white, I can't remember the name of it, but egg white protein molecule. So removing those from our diet. Yeah. What about, are legumes and nuts and seeds also part of the more stricter AIP? Yeah. So he's done a paper on it with regards to rheumatoid arthritis.

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And he proposed that some of the protein segments in legumes in particular very much looked like protein segments in joint tissue that were attacked. So that was his rationale for removing legumes as well because of these proteins that were difficult to digest and can have anti-inflammatory components. OK, interesting.

14:25
And just for those of you unfamiliar, nightshades, you find the, what did you call them? Glycoalkaloids. Glycoalkaloids in potato, tomato, chilli, red pepper, eggplant, things like that. Yeah, and there's a couple of other like ashwagandha. Of course. goji berries. Oh, nice one. I just had an idea.

14:56
And this is a little bit of a tangent really, but I'm interested to hear your thoughts on this because you're studying elimination diets in that autoimmune space. My read on AIPs, it's sort of gone out of favor over the last 10 years. It was very much, if I'm thinking about paleo, like the likes of Rob Wolf, Chris Cressa, Sarah.

15:19
Ballantine, believe her name, really big voices, and Amy Meyer would be another one who really sort of championed the autoimmune protocol up to a point. And now I feel like that's not the case anymore. Like, can you comment at all on how widely it's used and what maybe some of the critiques might be? It's still really widely used. There are literally dozens of Facebook pages supporting people doing

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the autoimmune protocol. So that's still out there. What did happen though was Sarah Ballentine did like a 360 degree about turn and said that the reason why the autoimmune protocol worked is because it improved nutrient density and food quality. And it was a lot less about removing these foods, which she went into.

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detailed rationale about on every single one, like why do we take out eggs? Why do we take our nuts and seeds? Why do we take out nightshades? And she kind of said, well, you the science wasn't that strong. And I'm kind of to blame for that because I made it look really strong. And I think it's much more about nutrient density and having a nutrient dense, you know.

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whole food diet is far more important than excluding foods. So yeah, that was her take anyway. Yeah, interesting. And I guess, you know, if I'm thinking about people who might discover the AIP, they might be coming from a standard Western diet that is really quite deplete of a lot of the important nutrients and things like that. maybe someone who is already following a paleo type approach,

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might not see the same relief because their diet is actually quite nutrient dense. Yeah, correct. I mean, my personal opinion is that I don't think, I think Sarah Ballentine, this 360 removal, I think she still sees a place for elimination diets. But because she is not in the space of a

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practicing nutritionist. She perhaps doesn't see or she hasn't looked at the elimination reintroduction food challenge studies that I've looked at. I think there definitely is a place for an elimination protocol with people with autoimmune diseases. I don't think necessarily that the AIP is the elimination diet.

18:14
And I think perhaps it's too restrictive and labels a lot of foods bad that shouldn't be necessarily labeled bad. Interesting. of course, we're going to dive into your paper next, when you, and I'm interested to know, was that, was what you just sort of thought about, that sort of landscape of people utilizing the AIP or Payload or other things, was there a gap?

18:44
in the literature of our understanding as to what truly works? Yeah, so in the literature, I looked at lots of reviews in rheumatoid arthritis and diet. And most of the reviews are very broad, or they will cover vegetarian and vegan diets as a group, or they cover Mediterranean diets as a group, or they'll look at the whole spectrum of diets across, you know,

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all different types of diets. And they'll include sort of up to maybe five or six studies that have an elimination reintroduction element, but nothing currently was published on just solely focusing on elimination reintroduction diets. And I knew from some of my kind of deeper dive into quirky finds and reference lists and older studies.

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that there were a lot more studies out there than had ever been included in a literature review. And the last kind of focused literature reviews were done in the 1990s. There was nothing since then on specifically on that topic. And because it's such the studies are so heterogeneous, there's anyone to include case studies and conference abstracts and kind of all kinds of things. I did a scoping review, which you can include all kinds of.

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different papers as a scope of what's out there rather than trying to make a decision on what the outcome is. Nice ones. Essentially, you're just looking at all available information and almost putting it in one place as to what do we actually know about this, including white papers and grey papers and not just peer-reviewed journal articles. Yeah, exactly. Yeah. Amazing.

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I think there's real value in that too, isn't there? Because only certain people will actually go to PubMed and look at research per se. And a lot of our information nowadays comes from the space that isn't peer-reviewed articles. It's based on maybe blogs or chapters and books from doctors, or I'm not sure if you've done that route, but things which aren't necessarily just in the ivory towers.

21:08
Yeah, yeah, so some of it came from, oh yeah, like certain books that had been published that weren't really, you know, included in PubMed necessarily, conference proceedings that were published, you know, in a book. So I've got a photocopy of what's in the book. don't, there's nothing, you can't find them online.

21:35
I had to get lots of interlibrary loans of things from quirky places around the globe. Nice one. Hey, Julianne, if I'm thinking about RA, what constitutes success with a protocol? What kind of markers and stuff are we seeing? it just self-report symptoms? And when I say just, I don't mean just because obviously that's hugely important.

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what blood biomarkers or anything else do we look at? Yeah, so with rheumatoid arthritis, there is kind of a I guess, a set of measures that a doctor or rheumatologist might use. It's called DAS 28. And I can't even remember what that stands for. Sorry. No worries. But basically, they look at the number of joints that are affected, the joint swelling.

22:34
A number of factors like how well they feel overall, a person's amount of pain on one to 10, for example, their fatigue on one to 10, a number of other measures like can you walk 3K is impossible. Yes, can do it with these activities of daily living, I guess. And also they might look at ESR, erythrocytes sedimentation rate, and C-reactive protein.

23:04
Initially, to diagnose rheumatoid arthritis, there are a couple of antibody tests, which are the rheumatoid factor and the anti-CCP, anti-citrullineated protein. Yeah. And if someone is, is positive on these things, then it's an official sort of RA diagnosis. Yeah. There's a number of things that they include, like how many joints are affected.

23:33
whether they have a positive test or not. I can't remember the whole thing, but there's a very clear diagnostic criteria for rheumatoid arthritis, considered rheumatoid arthritis. Yeah, and so if this, autoimmune protocol study, because it was all done online and because I didn't have any money really to spend like on expensive blood tests and things, I used two.

24:02
separate validated questionnaires. One was called RAPID-3, RA impact of disease, and another one called RAPID-3. And those two have been validated and tested against those more important tests that rheumatologists would use. But they're questions that people can just tick boxes and answer 1 to 10 online. So, yeah.

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And then if there is an improvement or resolution, that's going to show up in the responses from the RAID and the rapid three. Exactly. So if they answer, my fatigue level is eight out of 10. And by the end of the eight weeks, it goes to one or two out of 10. That is an improvement. So all of these different questions, a lot of them are rated out of 10. And then there's an algorithm for figuring out what's the overall number out of 10. And what I saw in

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seven of nine people was that all their numbers over the course of the eight weeks just tracked downwards. Yeah, and that's using the AIP. That's using the AIP, yeah, compared to like the four week habitual diet measures. So you could see that pretty much when they're doing their normal diet, everybody's jiggled down a bit, but they're pretty much a straight line across. And then when they started using AIP, it's sort of

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move down on most people except for a couple. Okay, nice one. So Julianne, something which came out of your scoping review was the lack of standardized protocols. And I guess, you know, I mentioned the rigorous AIP, there's paleo, there's people playing not fast and loose, just like thinking what is most important. For elimination and reintroduction, in an ideal world, what would a gold standard protocol look like?

26:02
And I've got clinically, and I actually think clinically is probably the most important thing. That's the thing people want to know. Like in real life, what is it, like, could you glean what would be the most important features? This is where it gets a bit tricky. Because all the ones I looked at, most of them were very, very limited and they did them for a short period of time. know, like they would have two different proteins, like,

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maybe fish or lamb and three different vegetables and three different fruits and spring water or filtered water. didn't even have tap water. And they would do that for a week and if they responded to that, their disease activity dropped, then they would start introducing one food at a time, either over meals or over two days apart. There was all different protocols.

27:02
Yeah, a week apart, some were two days apart, some were just a meal apart. Designing the best elimination diet protocol, I honestly don't know. You know what I get people to start with is just a whole, like a totally whole food diet. Because there's evidence, at least in cell lines and certain studies.

27:32
that there is a cumulative effect of all the additives in our diet. Like the preservatives, the numbers, the colors, things like that. Yeah. And emulsifiers, certain emulsifiers, texturizers, that improve food quality, preserve them, taste, et cetera. So there's that.

28:01
do know that things like just refined sugar can feed the wrong gut bugs and then cause imbalance in our gut bacteria. So just getting back to whole food, fruit, veggies, nuts, the whole spectrum, whole proteins, again, whole spectrum, seafood, land animals.

28:31
That would be a place to start. However, then when I looked at all the studies overall and looked at what, when people reintroduced foods, what were the foods that really stood out that people reacted to with rheumatoid arthritis? And there was some clear, like, if you look at the figures in the article online, you can see that the things that really stand out are cereal grains, in particular wheat and corn.

29:00
which I found really interesting, know, like maize, corn chips, corn tortillas, eggs. Which could be gluten free, right? Like, often you would have corn because Corn is seen as gluten free, but it's a cereal grain. perhaps the type of, it does have a type of gluten, like a storage protein. So maybe it's that that people react to. Eggs, dairy was common. And in the animal meats, there was

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pork and beef really stood out, which I found interesting as well. And anecdotally, I have had clients who say they react to that pork and beef, meat in particular. That's interesting, isn't it? So if I go back to the cereal grains, it, mean, gluten is obviously the first thing that comes to mind for a lot of people, including me, but I also wonder about the way that we process and the way that we harvest.

30:00
So is it the way that it's harvested and the pesticides and things like that? I don't know, because a lot of these studies go back before glyphosate, for example. people go, oh, it's the glyphosate. I don't think it's the glyphosate. Although we do know that glyphosate affects a certain number of. Glyphosate does affect us, because it can affect some of our gut bacteria.

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because in the same way that it affects the weeds and kills it. So maybe, maybe that. But I don't know. It could be just the refined nature of, there could be a multitude of things. It could be the gluten component. There's another couple of other components like wheat germ, a glutenin and wheat, which can act as adjuvant, which helps take, you know.

31:00
proteins across the gut barrier or makes us more reactive to proteins. So it could be that. I don't know. Or it could be just the whole refined nature of it. Like, highly refined starch digests in a different place than your gut, as opposed to, say, root vegetables, which tend to go lower down and a better food for our gut bacteria. So refined starch and sugars, they could just promote the growth of not

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the best gut bacteria and that might have an effect on inflammation in the gut. And I'm interested in the, you mentioned eggs and you mentioned beef and pork. What is proposed to be some of the proteins or the mechanisms specific there? Because I think most people would think animal protein is animal protein. They wouldn't necessarily think there's a difference between beef and lamb, for example.

31:59
don't know. The beef protein could be related to milk protein. I'm not sure. That was what one study did. It took out milk and all dairy and beef because there's a common protein component. Yes, I don't know. And beef can, you know, like I know from like

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seeing work with, I think it's Rodney Ford, and his work on eczema, and he did like skin prick tests for kids. And one of the things was beef seemed to be quite commonly reacted to for say eczema. perhaps there's a different protein in pork and beef that is just a more reactive protein for some people. And I think that's the thing, right? Like we're talking about this in the context of RA. We're not talking about this in the context of

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diet for the majority of people who might not have RA type symptoms? Yeah, exactly. mean, if you're completely well and you eat everything and you have a pretty whole, for the majority of it, a whole food diet, there's no reason to take any food out. I think that's the other thing that I've kind of changed over the years, like thinking that everybody had to be kind of scrupulous and follow.

33:26
a paleo type diet and cereal grains were not good for you. I really don't think that is the case. Like if you are 100 % well and you can eat those grains, then there's no reason to take them out of your diet. And I do, know, people often say this and I agree with them in that they're like the human body is it's complex, but it's also so sophisticated. And you would think that

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our guts would be able to handle and that, you know, a lot of the more modern type foods out there, notwithstanding. I think I don't know how, I don't think I'm alone in this. There will be people who think like me, obviously, but it's not, it's not very in vogue to say that there are good or bad foods. And I wholeheartedly think that there are good and bad foods. And it's almost like a very unpopular opinion these days. Yeah. This is a general comment too, it's a bit of a side tangent. Yeah, yeah. Like,

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Because the other thing I did with the autoimmune study, the IEP study, is I did a nutrition analysis and food group analysis. So I looked at the food group changes, and I also looked at the nutrient changes that happened. Because it's not often done with studies where they look at the nutrient changes that go on as well and then look at,

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Is there some way that those nutrient changes may have affected them? So what I found was their fruit and vegetable intake tripled. So they went from like three or four servings of vegetables a day to like 12 to 15. They went from one or two serves of fruit today to four or five. And consequently, their vitamin C levels went up. Their potassium went up. And both of those are linked to

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individual studies where rheumatoid arthritis activity decreases when you increase those in your diet through supplementation or food supplementation. And their fiber went up significantly because what they did, what people did was they had the recommended amount of grains in their diet, which is about six servings, but only one of those was whole grains. So they took out

35:47
five servings of refined grains every day. And they took out about 20 grams of added sugars every day and replaced those with fruit and vegetables. And so consequently, the fiber went up. And we know that fiber of certain types can be very positive for your gut microbiome just on its own. If we had a fiber supplement of about 15 to 30 grams a day of mixed fibers into the diet of people with rheumatoid arthritis, they're

36:17
gut permeability, their gut inflammation markers and their other inflammation markers decrease and their gut microbiome shows better activity. The same as if you add polyphenol rich foods, you also get that improvement. you know, is it that we've just massively put a whole lot of things in there, increased their gut microbiome diversity and

36:46
less inflammation, as well as taking out the stuff that increases inflammation. So there's so many variables when you change a diet, you know. And you've got to pinpoint variables. Julianne, I found it interesting because you mentioned in our group a couple of days ago that there were no published studies showing a, or looking at, I think you said looking at nightshade removal, this is one that I use almost all of the time.

37:15
Certainly for a lot of my clients, they see relief merely by taking out night, like we're dairy, we're gluten free, and we take out nightshades. And that tends to be my three sort of pronged initial approach for RA. what, so tell us a little bit about that. Yeah, so it is really fascinating. I actually did a blog post on it, looking back at the history of like, where did this come from that nightshades were a problem and found this agriculturalist.

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person, professor, who went to his doctor with gut issues and his doctor said, well, you know, you should take out nightshades because I think they're irritating your gut. So he took out nightshades and not only did his gut improve, but his arthritis went away. So he was on a mission and he got his secretaries all onto this diet. And then he got his secretaries and then he wrote a book and then he put a little postcard in the book.

38:16
and said, if you go on this diet, can you send me your results? So he got dozens of postcards back of people saying, I went on this no nightshade diet and my arthritis got better. And he knew as an agricultural guy that nightshades have this thing called glycoalkaloids. So if you eat old potatoes that are green, you will get really sick.

38:43
because the glycalkyloid content just goes up and up and up with the sprouts and the greenness. And in fact, when they develop new potatoes for the market, they actually have to test each variety for how much glycalkyloid is in them. And they have to fall below a certain point. Otherwise, they know that they'll make people sick. So glycalkyloids are a

39:08
disruptor in terms of gut inflammation. And that's where I think it starts. it causes, in more sensitive people, causes some increased permeability. And what we know with rheumatoid arthritis is that there are certain bacteria in rheumatoid arthritis that are in increased amounts.

39:31
we think that the proteins or whatever are in, if they cross over your gut bacteria, there's molecular mimicry to those proteins in the bacteria. So we want to keep our gut from not having that increased permeability. So black alkaloids seem to play a role there. It's interesting though that since that sort of initial discovery hasn't really been studied under any real scientific

39:56
to it with any scientific trigger. That's what I find fascinating as well. What opportunity? anecdotally, are saying, like several people in my studies say, if I have potato, my pain is worse the next day. Yeah. Very thoughtful. super interesting. Now, because kumara doesn't have it, does Sweet potato doesn't have. it's different from all together. Yeah. And we'll say that, so.

40:22
So other than that surprise, was there anything else surprising about what you found as you were sort of unveiling the information, sort of synthesizing it, Julianne, in terms of elimination or reintroduction or anything? I think the other thing I found interesting was that all the studies with elimination, any study that had an elimination component was

40:50
pretty much always tested against a standard diet. It wasn't tested against a diet of the same quality. I only found one true study that tested a diet against the same quality. So they did a Mediterranean diet, no alcohol and I think no meat in both of them. But one of them took out dairy and gluten and the other one kept dairy and gluten in. So apart from

41:20
removal of dairy and gluten, they were identical in quality and the people with the reduced gluten-free, dairy-free got better results than the people with the standard Mediterranean diet. So that's the only study that's been done. we just never know how much of a diet is because of like the AIP diet in my study, how much of it is like massively improved dietary quality.

41:47
and how much of it is because we've eliminated certain foods. And that is a study. Those studies just haven't been done and they do need to be done. And I mean, to your point that if you think about the most commonly reacted to foods, there are still quality foods in that list, right? Like in terms of protein, beef and pork aren't necessarily terrible, although pork does get a bad rap.

42:15
And, but anyway, and actually this is my bias because I really love a pork chop. maybe I'm just like, surely, surely not. And eggs, I mean, one of the highest quality foods that someone can eat, but of course something in them makes the immune system react and susceptible people. Yeah. And I think what's interesting is the commonality between the reactive foods and rheumatoid arthritis and possibly other autoimmune diseases too.

42:43
tend to be the top eight allergenic foods. So you know, you've got gluten, dairy, tree nuts possibly, eggs, maybe shellfish, but there's lot of crossover between common allergenic foods and foods that people react to. So I think it kind of makes sense that you take out those foods. Yeah. Now, tree nuts. Do you have a list?

43:14
Tree nuts are the nuts that grow on trees, like walnuts and almonds and Brazil nuts. Peanuts? Peanuts grow on trees? No, no, peanuts are a legume. Ah, of course they are. But I thought maybe that was the thing with peanuts. but peanuts are an allergenic. Yeah, yeah, yeah. As you know, people can die from peanuts if they're highly allergic. Yeah, yeah, but they're not a tree nut. They're a legume. No, no, no, they're under the ground nut. They're a ground nut. I surprised myself with...

43:41
my very limited knowledge in some of these things. Like, oh, was today's years old when Julianne and I discussed it. Peanut's grown a tree. They're on roots. Hey, what was interesting, I think, particularly is because a lot of people are very willing to shell out hundreds of dollars to get their problem diagnosed. You know, like give me the standardized test that is going to absolutely tell me.

44:10
what I need to avoid. What did your study find on that front? Yeah, so I isolated, I looked at all studies that had done various IgG tests, skin prick tests, intradermal tests, which is a little bit deeper than a skin prick, ELISA tests, and all these different allergy tests. And then they did an elimination reintroduction diet. And then they actually listed the ones they reacted to on the test and they listed the ones they reacted to.

44:40
on the elimination reintroduction diet. Some crossed over. Quite often things like gluten and dairy, possibly eggs. But then there were lots of things that didn't cross over. it was very hit and miss, I should say, in terms of whether it could illuminate a food that somebody reacted to for their rheumatoid arthritis. What it did show was more likely to

45:09
show foods that people were allergic to like hives or other types of allergy symptoms. Yeah. So the utility of these tests for some people, like if you're going to a doctor who specializes in allergic reactions and they use these tests, this is, you know, they're designed to sort of pick up things like that. But if you're thinking about your autoimmune condition, then

45:37
that the ELISA, the IgG, the SkinPrick might not accurately predict? Might not accurately predict, yeah. But you might take those foods out and get a good response because coincidentally, they were the foods that you are not good with. And typically, the foods that come up on those tests are the standard sort of more allergenic foods anyway.

46:03
And the IgG tests, they just react to foods you tend to eat the most of. I am constantly surprised to still see them in the roster of available tests that people can purchase. At like, you know, the practices that you and I would go to ordered tests for our patients, I'm like, wow, I just like, it's about time to retire that one, I would have thought. I would have thought too. Yeah, I'm just... Yeah.

46:30
Don't need to waste your money on that one, people. I wouldn't, you know. It could almost work though, like a food diary. You know, people talk about the ketogenic diet is like the one diet that has like a biomarker, because if your body is in ketosis, you'll see it in your blood or your breath or initially in your urine. Maybe the IgG test could go alongside some sort of like food diary as sort of proof that you are in fact eating a range of foods which people are saying they're eating. I mean, it's not very...

46:59
sensitive, but it's a little bit specific maybe. I don't know. Hey, but what about Julianne gut microbiome testing for something like this? Do you think that could be a valuable tool for people with an autoimmune? Of course, we're talking about RA, and appreciate, and for the listeners to know, Julianne is here talking about her research and her academic work, but she's also a very experienced practitioner as well.

47:27
So getting sort of the clinical insights as well as maybe the research stuff. I have not enough experience in microbiome testing clinically to see if it's validated. I think you need to be very clued up. And also the microbiome changes all the time.

47:55
I've looked at there are some microbiome. Some of the studies did microbiome testing, which I find really interesting. But I don't think it's necessary to do microbiome testing in order to get a result or to put a particular diet in place. So what one of the studies found was the closer

48:25
The better people's diet quality was in terms of a Mediterranean diet. This is just one study. The lower a particular bacteria called, I think it's Proteus, oh, I forget which one, sorry, is that tends to be high in rheumatoid arthritis. That was really, really low or missing in people that had really good quality Mediterranean diet.

48:54
their disease activity consequently was lower. In other studies, for example, there was a raw vegan diet with a lot of fermented foods. And they showed microbiome changes with the fiber content in particular that were associated with a reduced in disease activity. So we know, firstly, that changing your diet will positively affect your microbiome. Do we need to?

49:22
do all the tests to show for it. I don't think we know enough about the testing. There is a study called the ITIS study, which is doing ongoing testing, microbiome testing. So that's a diet that is showing really good results in rheumatoid arthritis. So basically it's almost a Mediterranean AIP diet cross, I would almost say.

49:52
high fiber, high polyphenols, high nutrients, no red meat because they looked at the research around red meat, no dairy.

50:04
no gluten, no nightshades. One study that they've taken nightshades out and increased fermented foods and all the polyphenol and fiber rich foods and omega-3 rich foods and olive oil like olive oil and nuts. Yeah, they have olive oil and nuts and seeds. Yeah. Yeah. So they do include all the nuts and seeds and olive oil. And they had in their pilot study, 50 % of people had a reduction

50:34
a 50 % reduction in pain and fatigue in two weeks. amazing. Yeah. And they're doing an ongoing study where they're testing that ITIS diet against a good quality Mediterranean diet. And at three months, 11 % of the people on the ITIS diet went into remission and none on the Mediterranean diet. That sounds like pretty clinically meaningful. And particularly for the people who are in remission, that would be

51:03
Yeah, clinically meaningful means, you know, all those markers out of 10, they have to go one or below. Amazing. Yeah. So basically in my AIP study in eight weeks, all by one person was one or below. So that was all also clinically meaningful. And four people out of nine had a clinically meaningful reduction. it reduced from like five to one, for example, there's a certain gap.

51:32
Yeah, so the ITAS study is showing clinically meaningful results and whether it's excluding the foods, whether it's adding more fruit and vegetables and polyphenols and fermented foods or just a combination of the whole thing is like hard to know for sure. Yeah, that's super interesting. Julianne, with the foods that we mentioned in your graph that showed the most likely contributors to the symptoms, the beef, the pork, the eggs, the corn,

52:01
the grains, both from your read of the literature and also clinically, does every single person respond to every single one of these foods or is it trial and error as to which one's going to trigger? Yeah, it's, yeah, not everybody responds to all those foods. Yeah, it's definitely trial and error. Okay, yeah. And how long would you expect someone to need to eliminate a particular food or

52:31
or maybe shift their diet to be more representative of something like the ITIS. How long would it take them to, I you mentioned three months in that study and four weeks and eight weeks in your study. Yeah. So what was interesting about my study and it's not published yet, but hopefully it will be in the next few weeks. The graphic showed that the most change, it was a progression. So it didn't suddenly go, okay, in two weeks they drop.

53:00
right down, it showed a slow progression and between weeks five and eight, that was when people really hit the ones and the twos out of 10. So I would suggest if people were doing like an AIP or an ITA style diet and wanted to reintroduce foods, eight weeks does seem to be a good length of time. Okay, interesting. And then with the ITA study, you mentioned obviously fermented foods.

53:29
And polyphenols, polyphenols for people who are unfamiliar as to what we're talking about. Yes, polyphenols relate to how they're the colors, pretty much the colors in foods are polyphenols and they have a particular chemical structure. And the polyphenols seem to be very anti-inflammatory.

53:59
gut level. So they seem to feed the good gut bacteria. They seem to reduce inflammation in the gut. there are metabolites. that's, you know, the gut bacteria will let off little chemicals in those metabolites, then float around in your body. And so there's a lot of anti-inflammatory metabolites that result from more polyphenols. Yeah, nice. And then

54:29
If someone was listening and they were like, I've got this great greens powder or I take nutrient rescue. Do you think that that would take the place of all of the fruits and vegetables that people should be aiming to include? what's your, like because of the polyphenols that you'd get in those products? you think they're going to mature? I think they'd definitely help for sure. But it's not just the polyphenols. It's the complete food because it's the fiber as well.

54:59
Yeah. Okay, makes sense. Julianne, like, I don't know how what your interactions are like with doctors in the space of autoimmune or diet related protocols, but often people are met with, diet changes are dismissed actually as being at all effective in these types of conditions. Do you have any suppositions as to why that might be? Cause they're not, they don't spend

55:29
hours looking at the research. Yeah. And they don't work with clients who change their diet and see results. Okay, good. Yeah, yeah, yeah. Yeah. I'd say those two things. Also, just because of the quality of the research in general, the professional bodies are very conservative in their recommendations. But I think their recommendations are a good start. I mean, they recommend, you know,

55:57
Mediterranean style diet, but it's not just Mediterranean. It's increase your fruit and vegetables, increase your whole grains, increase your olive oil, your good fats, take out your saturated and trans, remove your trans fats and saturated fats. You know, cut down on sugar and find carbohydrates. So there's a lot of good advice there, but and that is clinically shown to be effective. So I don't know why they didn't even start with.

56:27
You know, we know that this helps. And you mentioned saturated fat and this is the, like we haven't really delved into that aspect. And I might be, I'm just thinking about what I know about saturated fat. Is it the gut microbiome interaction which increases inflammation? It seems to have, at least the studies they've done in rheumatoid, there seems to be a negative interaction with the gut microbiome in saturated fat.

56:57
And I just want to bring in the other thing about the seed oils in Omega-3 and Omega-6 as well, because that's just a huge topic with, know, shirtless men running around supermarket aisles. I miss that, You have to tag me in that one. oils in products and saying how toxic they are. Yeah. So it seems as if, at least in rheumatoid arthritis, decreasing Omega-6 and increasing Omega-3.

57:28
work together to have an anti-inflammatory effect. Cool. And so if we're thinking about Omega-6, where do we find Omega-6 in the diet? Probably in some vegetable oils more than others, like soybean oil, safflower oil, and a few other oils have high amounts of Omega-6. Do you know, Julianne, this is a whole other...

57:57
topic of conversation. But I was even just listening this morning to someone talk about seed oils, because it is, particularly in our space, really prevalent. And you and I have both come, well, no, we originated from not even really thinking about seed oils, obviously, but then in the ancestral health sort of space, they were definitely a no-no. And I don't know. know that, I mean, I think our positions may have changed over the years. And I look at

58:25
seed oils and think, well, they're really cheap. They're sold in plastic. They're not necessarily protected from light. And actually, for the most part, in most diets, unless you're adding them and cooking them, which actually a lot of people are because they're so cheap, then it's the processed food that we're going to find these Omega-6s in. Where are you on that? And I'm privileged, I'm lucky enough that I don't have to buy

58:53
cheap oil to cook in. just tend to buy better oil and use less. what are you, where are you with that? Yeah, I think all of those, you know, the fact that, yeah, the plastic bottles, the exposure to light. And, or the other one that I think people like boiling your food in oils, deep fryers, I think, we've neglected

59:24
I don't know if going back to tallow is the best answer. think probably minimizing deep fried food together is probably the best thing. I don't think there's anything healthy about boiling potatoes or boiling- I love that you're calling it boiling. It is. You're boiling food and fat that has been reheated over and over over and over again. Those toxic components build up every time you heat it. If they've got a lot of omega-6,

59:53
fatty acids, they're very, very unstable chains. So what will happen is they become oxidized and oxidized fats are pretty damaging in your body. Now I feel like we're on the same page with that. Like I certainly, there are things that I eat, like hummus, for example, I buy hummus from a supermarket, it has, I don't know.

01:00:17
Probably canola oil, is more omega-3s than omega-6s. Yeah, it's mostly monounsaturated fat. It's very similar to olive oil. Yes, yeah, yeah. Toxic canola oil, where actually, where's the toxins? Yeah, so we're not boiling our food. Yeah, we're not boiling our food. We're not high heat cooking and easily damaged fats. Yeah, yeah. Okay, so I guess my final question, Julianne, is...

01:00:46
You all of these, I guess, you sort of talked us through what you might do with your clients in terms of an elimination diet, the length of time, the types of foods to focus on including and excluding. You've got this new study that is about to be published. Where to after that? Good question.

01:01:14
I really have to think. mean, if I had a good structure, support, money, et cetera, et I think it would be really good to bring all this dietary information together and do a study whereby you had two good quality diets and one excluded some foods.

01:01:40
and see what happened and also allow time for a reintroduction period as well and rheumatoid arthritis anyway. I would like to see a study where the minimal amount of food was excluded and perhaps the sort of really obvious ones that were highlighted in the previous food challenge studies.

01:02:06
Also, we need to understand mechanisms. That's the other thing we don't know. We don't know why, you know, what changes in the microbiome, what changes in gut permeability, what changes in kind of inflammatory reactions at a gut level or immune reactions at a gut level or immune markers in the blood or metabolites in the blood or this. Yeah, there's so many different things that could be measured, but.

01:02:36
That will be a big study and a lot of work and a lot of money. So that's maybe one possibility. Or maybe I will just use my knowledge and sort of do more kind of maybe group work or something like that, like working with people with rheumatoid arthritis, putting these principles into practice. Because I think there are some fairly standard principles that have come out of this that we can put into practice that will improve the quality of life.

01:03:05
for a lot of people. Nice one. And actually my final question, obviously RA is a specific type of autoimmune disease. How transferable are these principles to other autoimmune conditions? Do we have any idea on that? We don't really. I mean, I've worked with a few people with ankylosing spondylitis, for example, but they seem to do better on a lower starch.

01:03:34
diet because the type of bacteria in the gut that's dysbiotic is different from that which is dysbiotic in rheumatoid arthritis. So there are differences there. I work with psoriatic arthritis and those people tend to do pretty well on a paleo style diet. There are a couple of studies done on Hashimoto's but the

01:03:57
the results weren't resoundingly good. People got better quality of life and less fatigue, but they might have got that just improving their dietary quality anyway. So it's a little bit hard to know. And the foods that people react to just seem so hit and miss. Yeah, I think improving dietary quality and removing potentially some potentially antigenic foods like that low-hanging fruit.

01:04:26
is where you could go with pretty much any autoimmune disease. Okay. Awesome, Julianne. Can you please let the listeners know where they can find you and potentially more of your research? And of course, I will put in your new scoping review and a link to the blog you wrote about your pilot. Did you say you wrote a blog about... Well, you've written a couple of things around your research and I can't remember what else you said, actually, but...

01:04:54
You wrote, oh yeah, I wrote about that, but I'll put links to Yeah, I wrote about nightshades. That's right. I wrote a blog about nightshades because I found that fascinating. So my older blog is Paleozonenutrition.com. My sort of nutrition website is JulianneTaylorNutrition.com. I have done quite an in-depth talk for the New Zealand Arthritis Society.

01:05:24
which you can find on YouTube, which I do go into that kind of detail around the mechanisms and the studies around rheumatoid arthritis and diet and look at the whole gut connection. yeah, I haven't been very good at keeping my up to date. None of us are, but you're also very active on Instagram as well. do post little bits on that because it's easy and I don't have to.

01:05:52
think too hard. And also people can catch up with your powerlifting endeavors and because you're off to world soon, aren't you? October. Amazing. You'll be in the throes of lots of training right now, I'm sure. Yeah, training four times a week. Nice one. Hey, Julianne, thank you so much for your time. Always appreciate it and the opportunity to. It helps me because it really

01:06:19
allows me to pick your brain a little bit on some of these questions as well. So I think people are going to find this really, really helpful. So thank you so much. Thank you. Thanks for having me.

01:06:42
Alrighty, hopefully you enjoyed that. I just love what Julianne is doing right now and I can't wait to see how the remaining part of her research pans out and of course how she does in World's this year for her powerlifting. Alright team, next week on the podcast I chat to Dane Fuller from Eat Fuller Foods. I studied with Dane actually at Otago and we discuss his nutrition philosophy and bringing product to market with

01:07:11
eat full of foods and his protein oats, overnight oats, and I really think you're going to love that conversation. And just to remind you that Monday's Matter Registration is open now until Friday this week, if you're listening to us on Wednesday. This is my eight week fat loss program that's designed to give you not only quick wins, but couched in an approach that could be your forever diet. There's a ton of support, community engagement. I am there beside you with

01:07:40
hundreds of other people helping you see out this season in your best possible shape. You can find details on that in the show notes and of course at my websitemikkiwiliden.com or hit me up in the DMs. I'm on threads X and Instagram @mikkiwilliden, Facebook mikkiwillidennutrition. All right team, you have the best week. See you later.