Navigating Setbacks

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a spiky desert plant covered in thready tangles“Resilience isn’t a superhero trait. We talk of “conquering” limitations, beating back disease, overcoming loss. The reality is much more complex. Those friends and clients who have been amazing models of resilience have also been fully, richly human. Not every day is a good day. Not every step leads you forward. Not every battle is won. We all pick ourselves up at some point, and some days we let ourselves stay “down” a little longer than others. We feel what we need to feel. The pivotal point is recovering yourself and reengaging your life on renewed terms”
~ Mark Sisson

Please Not This! 

You’ve embraced the paleo diet and lifestyle, noticed a huge reduction in your autoimmune symptoms, and overall you’ve been feeling great and grateful. Suddenly, out of nowhere, your autoimmune symptoms flare and remind you of where you started. What’s happening, and how can you quickly return to feeling better?

How Long Have You Been Paleo?

I always ask this question first, because autoimmunity doesn’t turn off and on like a light switch. While the paleo diet and lifestyle is a powerful healing tool, it’s healing at a cellular level and that takes time. It’s actually normal to continue to flare occasionally. You should see improvements – your flares should diminish in both number and intensity, but if you’ve only been paleo a month or two, continuing to flare doesn’t mean anything’s “wrong.” Take good care of yourself to help it pass quickly (lots of sleep, bone broth, sunshine and nutrient-dense foods). Stay committed to your healing lifestyle, and keep a symptom diary to mark your improvements. It will calm your fears during these moments.

Are You Doing Regular Paleo or the Autoimmune Protocol (AIP)?

Some people are lucky and see huge improvements in their autoimmune symptoms with a regular paleo diet. Others need to take it further. The AIP is an elimination diet that helps you identify additional food intolerances. It’s also a program that reminds you to focus on the importance of nutrient-dense food choices and a healing lifestyle. I started with a version of regular paleo myself (The GAPS Diet), and within 5 months I went from being disabled to being functional, from being in excruciating pain to mild pain, from having daily flares to flaring just a few times a month. It was a huge improvement, but I plateaued in my healing. That’s when I was ready to try the AIP. Within a few more months, my pain dropped to a whisper and years passed between flares. If you aren’t familiar with the AIP, I have a book that makes it as easy as possible.

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Are You Focused on Nutrient Density?

Healing diets aren’t just about the inflammatory foods you remove. Our bodies need deep nutrition to thrive. If you’re eating a small number of foods in rotation, that’s not a nutrient-dense diet. Variety matters, even on the AIP. Use this grocery list as your guide and see how many different foods you can eat each week. Follow the AIP Food Pyramid to see which ones to prioritize. And while we all can enjoy the occasional sweet treat or convenience food, the majority of our meals should be real food that doesn’t come from a box. That’s a truly healing diet.

What Is Your Lifestyle Like?

Many of us find it easier to make good food choices, than to address an unhealthy lifestyle. We convince ourselves we have no choice. That life is too busy to get enough sleep. That we can’t cut down on our commitments; people depend on us. That we can’t ask for help; it’s our responsibility to take care of others, not the other way around. That we need our jobs, even if the level of stress is out of control. That we’re stuck in a toxic relationship, whether with a family member, friend, or spouse, with no way out.

If you feel trapped in your choices, ask yourself this powerful question: “Is that really true?” Look at your life and see where you have options. If you really believe you have none, it’s time to consult someone more objective – a good friend or even a therapist, to show you alternatives. You can begin with baby steps. Drop one responsibility from your life that brings you no joy. Say no the next time someone asks you to volunteer. Delegate some of your chores to other people in your household. Turn off your computer (or TV) and go to bed an hour earlier every night. Start looking at job listings, just to see what options exist. Set yourself a 30-day stress management challenge, where every single day you do something for 15 minutes that relaxes you. It can be anything from a bath, to meditation, to yoga, to an adult coloring book, to reading a novel. For the big changes, start visualizing a different life. Picture it first, and then break it down into action steps – what is the first thing you need to do toward creating that new life? You are more powerful than your realize.

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Do You Need Help Beyond Diet and Lifestyle?

Sometimes we see the world in black and white, believing that the only paleo success story is someone who has achieved a medication-free remission. The reality is that there’s a whole spectrum of autoimmune healing, and that will look different for each of us. I get emails from people who are taking the strongest medication available and still experiencing loss of abilities and severe autoimmune flares. That’s what motivates them to try the paleo diet. While most people are able to reduce their medication after 6-12 months of living the paleo lifestyle, not everyone can eliminate it completely. And that’s OK. Some people have more aggressive autoimmune diseases than others, and the combination of medication plus diet is what improves their quality of life. Whatever keeps you living your healthiest life is cause for celebration. Medication is not failure.

Do You Have An Underlying Health Issue Not Yet Diagnosed?

Autoimmune healing is a marathon, not a sprint, and there are often many layers to healing. If you are doing everything right and making no progress, it’s time to do some detective work on your own body, and that’s where functional medicine comes in. Sometimes an infection or parasite or hormone imbalance can keep your immune system overstimulated, in spite of your best intentions. Healing underlying issues might be the key to breaking through your personal road block. Check out this list of directories for a practitioner near you. Many people also consult worldwide via telehealth.

Have You Started Any New Supplements or Medications?

If you have an underlying health issue, that will normally be treated with a new supplement or medication, and one of three things will happen: (1) It will help you feel better. (2) It will have a neutral effect. (3) Or it will make you feel worse. Sometimes we don’t consider option #3. We think if something is prescribed to help us, then that’s what it will do. Autoimmunity is more complicated than that, and a treatment that puts one person into remission, might cause another person to flare. I don’t say this to scare you away from treatment, but it might take some trial and error to find the intervention that works for you. Here’s my advice:

  1. Only try one new supplement or medication at a time. That way, you can monitor your body for improvements vs. inflammation, and see the results clearly and quickly.
  2. Read the labels on your bottles carefully. Many supplements contain non-paleo ingredients such as dairy, soy, grains, etc. Choose supplements that are allergen-free with a minimal number of ingredients, and if there’s one you don’t recognize, call the manufacturer for details. When it comes to prescriptions, you can ask your pharmacist these questions.
  3. Be careful of bargain hunting. In 2015, the New York Attorney General’s Office did an investigation into the generic store brands sold by Wal-Mart, GNC, Target and Walgreens, and found that 4 out of 5 supplements didn’t contain the herbs advertised. Instead, they contained cheaper ingredients not advertised on the label. Buy a brand that you trust.

Are You Suffering From Overtreatment?

This is the flipside of functional medicine consultation. Sometimes after a battery of tests, you discover there are many underlying health issues to address. These are best tackled one at a time. If you try to do too much too fast, that can be overwhelming to the body and cause a flare as well. Work with your practitioner to help you prioritize. The good news is that healing can have a domino effect. Working on the most important problem sometimes has the side effect of healing the rest.

Whatever the Cause, Give Yourself Time

Autoimmunity is tricky. Once our immune system ramps up into overdrive, it takes time for it to calm back down. While we hope a flare will pass quickly, sometimes it takes a couple of months before we feel “back to normal.” This doesn’t mean we need to troubleshoot. Really, we just need to give ourselves time. This is an opportunity to focus on something else. It’s easy to get obsessed with autoimmune healing, where every free minute is spent researching the science of our disease or the latest intervention. Do you have hobbies and interests outside of autoimmune healing? If not, it’s time to get some. Freeing ourselves from worry can be an important step toward feeling better.

Seek Progress Over Perfection

Sometimes we set impossible goals for ourselves. Every setback feels like a personal failure. It’s important to remember that there is a difference between reversing autoimmune disease and a cure. Reversing autoimmune disease is about slowing disease progression, reducing symptoms, reclaiming abilities, and improving quality of life. These are huge accomplishments! But it’s not a 100% cure, which means that setbacks will sometimes happen. Remember this: you are not a failure if your health isn’t “perfect“. You’re simply human. Celebrate your successes, have compassion for yourself during setbacks, and strive to love yourself through it all.

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A version of this post originally appeared in my column in Paleo Magazine.

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