On today’s show, we’re talking about the role of diet and lifestyle in treating autoimmune diseases. Janet is my guest for this episode. She’s been a nurse practitioner for 27 years, but today she’s here to talk about her experience as a patient with Crohn’s disease, and how she got her autoimmune disease into remission using food as medicine.
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On today’s show, we’re going to be talking about the role of diet and lifestyle in treating autoimmune diseases. I’m so thrilled to have a guest with me in the Gutbliss Podcast studio. I have Janet, who is a nurse practitioner. She’s been a nurse practitioner for 27 years. She has worked extensively in the hospital in transplant surgery and in surgical critical care. I also had the honor of having her in my office for a short while doing outpatient gastroenterology helping patients with autoimmune diseases. But today she’s here to talk about not her incredible professional career, but her experience as a patient with a serious autoimmune disease. Janet, thanks so much for joining us. So tell us a little bit about your autoimmune disease when you were diagnosed?
Yeah, so, you know, I was in the military when I came out of college and sometime about two or three years into my military career when I was 24, 25, I started having these very ambiguous symptoms, abdominal pain that would come and go. And you know, it got worked up and no one really knew what was causing it. And it culminated when I was in graduate school for my nurse practitioner degree with a lot of abdominal pain, vomiting. And I ended up having my gallbladder removed as a consequence of that, but still not an actual diagnosis of what was going on. In 2005 was when I finally had a CT scan that showed the inflammation in my terminal ileum, the last part of my small intestine. And that was when it was determined that I had Crohn’s disease.
And did they diagnose Crohn’s based on the CAT scan or was there some other tests that they did to make the official diagnosis after the inflammation showed up on the CAT scan?
So after the inflammation, I did have a colonoscopy, and they took biopsies at that point, and it was shown that I had the inflammatory cells and markers that were indicative of Crohn’s.
So for those of you who are a little less familiar with Crohn’s disease, Crohn’s disease is one of two autoimmune diseases, Crohn’s is one, and ulcerative colitis is other, that form what we call inflammatory bowel disease, IBD. Not to be confused with IBS, irritable bowel syndrome, completely separate set of diseases. Crohn’s disease involves any part of the bowel, really from the mouth to the anus. Most commonly, it involves the terminal ilium, the end part of the small intestine where Janet’s was found, but it can also involve the colon. It can involve higher up in the stomach, the duodenum, etc. And Crohn’s involves the full thickness of the bowel wall. And that’s why it can lead to a lot of complications like fistulas, which are connections between adjacent pieces of bowel or sometimes adjacent organs and bowel, obstructions where you get narrowing, and strictures. It’s because the full thickness of the bowel is involved. In contrast with ulcerative colitis, which only affects the colon and really just the lining of the colon. So similar diseases, and we don’t know what causes either of these two diseases, but we think it is a combination of genetic predisposition and some environmental triggers, diet, lifestyle, medications, previous infections, sort of a complex mix like most autoimmune diseases. In your case, Janet, if you think back, you were in the military, as I recall, there might’ve been some jumping out of helicopters and other things involved. You come from a very distinguished military family. And I know for you, this is not a big deal, just another day at the office, but was there anything going on at that time from a stress point of view? Because a very interesting fact with Crohn’s disease is that 90% of people with Crohn’s disease are diagnosed before their third decade. They are diagnosed like you, late 20s, early 30s. I think you were around 30, is that right? And many are diagnosed in high school and college, so that’s a period of change. There’s a period of change in our bodies, hormonally, in teenage years, but also it’s typically a period of change in terms of what we’re experiencing emotionally. Was there anything that was going on that you look back in retrospect and think, hmm, I wonder if that has something to do with it?
Yeah, so I think the one thing that I really point to and think about a lot is, you know, I love the field of nursing. I’ve been a nurse for a long time, but at that time I really was doing a lot of night shifts, back and forth, flip-flopping. I think my sleep was definitely disrupted. I definitely think there was stress, you know, the work environment is stressful. But I would say I think the sleep disruption is probably the lifestyle factor that I can point to. The other thing I think that was an issue is when you sort of look across the span of time of what my food influences were when I was young and on my own and making my own meals and cooking for the first time away from home with my career, I mean, that was really the time that the fat-free and low-calorie movement was at its height, you know, so I would go to work and take my Lean Cuisine meal and my SnackWells crackers and I’d be super happy that I was having this 500 calorie meal with low fat and I wasn’t paying any attention to the ingredients that were in my food. So I think we’re going to talk about food too as a factor that influences all of this, but I definitely think that was a part of it.
And those are two really big factors, sleep and food. And again, I want to make it clear to anybody who’s listening; we are not suggesting that SnackWells and Lean Cuisine cause Crohn’s disease or even that sleep deprivation causes Crohn’s disease. But again, it can be this perfect storm of family history – some sort of genetic component in about 20 to 25% of patients with Crohn’s – and then these other environmental triggers. 10% of the time it’s an infectious antecedent event – somebody goes on spring break somewhere, they get traveler’s diarrhea, they never recover. It can be the Standard American Diet – a known trigger for some people. Antibiotics – that’s very well established in the literature, particularly antibiotic exposure in children. Stress can be a trigger. So it’s very important to understand that we’re not saying that any one of these things causes autoimmune disease, but these are the things that can conspire, if you will, to affect our immune system. We know that sleep is very, very critical for the immune system. And if you look at something like vaccine efficacy, an incredible study that was published in the last couple of years showed that sleep deprivation in the 48 hours before you receive a COVID vaccine can reduce the efficacy of the vaccine by as much as 50%. And we’ve seen the same thing with vaccines for hepatitis, for influenza. So we know that sleep deprivation in the period immediately prior to receiving a vaccine makes a vaccine less efficacious; less antibodies are produced by the body. And similarly, we know that sleep deprivation makes you more susceptible to viral illnesses and bacterial illnesses. There’s some incredible statistics on people getting COVID who are sleep deprived and having more severe disease and being more likely to get infected. So we have clear evidence that sleep affects the immune system or rather lack of sleep. We need sleep so that we can reboot our immune system and make sure that we are pumping out those antibodies and cytokines and all those other immune factors that are necessary for keeping us healthy. And so a disruptive sleep cycle is common, particularly in the early days, right? When we’re interns, residents, junior nurses, sleep is not a high priority. And often it’s a shift, like going from night shift to a regular shift, things like that. And then food, and Janet and I were talking about this earlier, about what they feed people in the hospital: bacon – a known carcinogen! Some of these IV and enteral feeding tubes that are just full of high fructose corn syrup and things like that. So unfortunately, the food in the hospital – both the food that patients are getting and the food that we are getting as staff – is really not ideal. You go to any physician’s lounge in any hospital in America, and you’re typically going to see soda and chips and cookies and donuts, and maybe there’s some salad or fruit in a cup, but it’s a lot of ultra processed food. And then you’re working these long shifts on the go. So you describe the sleep disruption, the food. What about any previous infectious illnesses? Had you had anything that you can think of?
So I can’t really point to a previous infectious illness. We’ve talked about my background, and I was vaginal delivery, I was breastfed. I did have a lot of ear infections as a child and did receive a lot of childhood antibiotics. But I would say in general, our family philosophy was really to try to avoid medications, live a healthy life, you know, get outside. We did all of those things. I also think that we were subject to the Standard American Diet. That was a time when convenience food, of course, was something that we thought was fun and compelling. And so Kraft macaroni and cheese night was a fun night at our house, and we all looked forward to that. So, you know, there are some things that infiltrated our life that I think probably contributed to the Standard American Diet, if you will.
We’re really only seeing now with a lot of the data on ultra-processed foods, how deleterious these foods are, not just for things like creating autoimmune disease and so on, but also for things like dementia, cognitive function, and in fact, a higher risk of dying prematurely. Dr. Monteiro in Brazil and others have come up with the NOVA classification for ultra-processed foods – it’s a great classification to familiarize yourself with and we’re really talking about those NOVA class 4 foods, things like Kraft macaroni and cheese that come in a box, long shelf life, tons of chemical ingredients that you should not be ingesting. And not to pick on Kraft particularly, but in general, a lot of these convenience foods. So you’re diagnosed, this is now 20 years ago, and what did you think? I mean, you’re obviously very familiar with Crohn’s disease being a healthcare practitioner. So when you got the diagnosis, what was that like?
I think there was a lot of disbelief, but it also gave a name to my symptoms, which at the time when you’re a healthy young woman and you’re exercising and you’re doing what you think is a healthy lifestyle, to get a name for something that’s been plaguing you is helpful. But the one thing that really stands out to me – and I think it’s informed my entire relationship with Crohn’s for the last 20 years – is really what I was being told in the time that I was diagnosed and before you and I met. And really the messaging that’s out there still, it angers me, it fuels me, but it’s really been the common theme, is that food doesn’t matter, and it doesn’t matter what you eat, you’re not going to change your disease. And that for me, I think, was really confusing in the beginning because I didn’t have enough information to really be a motivator for how I was going to change my life, but I knew, I just knew, that that wasn’t right. And I remember, I think I told you, but I had a funny interaction with my mom, who, thank you mom, you are right, as always mothers are, but I remember she said to me when I first got my diagnosis: “Well it must be something that you’re eating” and I remember being so incensed by that and I said: “Mom, you know you can’t treat me that way, that’s not what this is about, it’s not! The doctors tell me that there’s nothing I’m doing; there’s nothing that I can eat that will change this!” So this is an apology and an anthem to my mom because she was right. But also to really home in on that because that was the anger and the frustration that I was feeling over this. And even to this day, I think I told you I was watching a video about a woman who has a fermenting food business, and she said the same thing.
And let’s give her a shout out because you love her so much.
Yes, I do, I do. It’s Fermenting Fairy and it’s Lauren Mones, and I love her products. We’ve talked a few times on e-mail, but I don’t know that she knows that I’m going to be shouting her out, but I am. I just think her products are great and my entire family eats them.
And there is actually great scientific data for fermented food, for improving the microbiome, which we know is ultimately going to help diseases like Crohn’s and ulcerative colitis. But this idea of the doctors saying there’s nothing you can do, food doesn’t matter; this is still sort of gospel in gastroenterology today: food doesn’t matter. And part of trying to deliver a message of food as medicine, the tricky part, is some people perceive that as: “This is fantastic, and this is empowerment. And so what you’re saying is by changing what I eat, I can change the course of my disease, fantastic!” And other people take that same information, and they perceive it as: “You’re saying it’s my fault and I’m to blame”. And it’s something I think about a lot because most of the diseases that I treat in the gastrointestinal tract are not people’s fault, but there are things that people can do to improve them. There’s always something that you can do to improve it. And so I’m constantly thinking, how do I give that message in a way that feels empowering rather than blaming? And I remember having a conversation with my friend and colleague, Drew Ramsey, who’s a psychiatrist, what he calls “nutritional psychiatry”. And I said, Drew, I struggle with that a lot. I want people to feel empowered by this, that there’s stuff they can do, but I don’t want them to feel like I’m blaming them. And he said something that really stuck with me. He said: “With illness comes responsibility”. And I thought about it, and I was like, yeah, it’s kind of like with parenting, right? Like, we can’t just be like: “OK, well, see you, I’m off to the gym for four hours. You kids figure out what you’re doing.” With parenting comes responsibility, you have to do things differently. With home ownership comes responsibility, with jobs come responsibility. So when we are struck with a serious illness, like you were, with Crohn’s disease, while there is an element of victimhood for sure, right, this thing happened to me, there is also the responsibility of “how can I make this right?” And for some people, that responsibility is, well, I’m going to do everything the doctor says, I’m going to have the infusion, take the steroid, whatever it is. And that’s perfectly fine. That is a legitimate path for many people. But there’s also the path of, I’m going to build a platform of eating the healthiest diet I can. I’m going to live the healthiest lifestyle. I’m going to get sleep. I’m going to exercise. I’m going to nourish my body and then see what I need on top of that. And I don’t know why with the medical community, it seems to be either or.
Right. I agree. Yeah, I think it’s more just, I don’t want to say ignorance in a bad way, but I think it’s just the lack of information that we have about what’s out there and then sifting through it. There is so much to sift through, and we have to, I think, give some kind of deference to the fact that when you first get started on this journey, you feel like it’s so overwhelming you kind of don’t know what to do. And that’s a little bit a part of what’s helpful, I think, to have these types of discussions, as you can kind of guide people in the right way.
Well, I’m so glad you’re joining us today. And when we come back, I want to circle back to something you said a minute ago, which is that they maybe just don’t know. We are back talking with my friend and colleague, Janet, a nurse practitioner with 27 years of experience in transplant surgery, in critical care surgery, and 20 years of experience as a patient living with Crohn’s. So Janet, you said something right before the break. You said that the doctors – whether it’s because there’s too much information to sift through – maybe they just don’t know. And I want to follow up on that point, because I was one of those doctors who just didn’t know. I was trained in my first eight years – four years of medical school at Columbia, three years of residency at Columbia, a year as chief resident – then my GI fellowship at Mount Sinai. And Mount Sinai is a hospital in New York where Dr. Crohn first described Crohn’s disease with Dr Ginzburg and others in the 1920s. So it was 100 years ago. And we had incredible training at Mount Sinai. We were taught everything about the disease. And it was a very collaborative approach with surgeons and pathologists and biostatisticians. I mean, it was an incredible environment to do my gastroenterology training and learn about Crohn’s disease, the world’s expertise right there. But we spent most of our time talking about “what”. What is this: Crohn’s or ulcerative colitis? Is it ulcerative colitis, indeterminate colitis? But not “why”. Why do people get this disease? And that’s just something in the medical community where it’s not a question we really ask. We’re very preoccupied with the what in terms of what’s the correct diagnosis and the what in terms of what’s the correct medication and the what in terms of what’s the correct surgical procedure, etc., but not the why. And 30 years ago when I was in medical school, it would have seemed like a ridiculous question. Why? Like, why? I don’t know. We don’t know why these people get these diseases. They just fall from the sky. And again, we’re definitely a little bit closer. It’s not a straight line. It’s not the same for everyone. It’s kind of like cancer. There are dietary factors. If we look at colon cancer, like red meat consumption, there’s family history, there’s other environmental triggers, some of which we don’t even know about. There are things in the food and the environment that are creating cancer cells within our body and some of those things we can’t do anything about because we don’t know about them. But I just always want to remind people that it’s not a straight line from one thing, from even something like early antibiotics, which we know is a contributory factor. There’ve been multiple articles published on this. Lots of antibiotics early in childhood increases your risk of autoimmune disease like Crohn’s. That is indisputable. But we still can’t say that antibiotics cause Crohn’s because there are many children who receive multiple courses of antibiotics and don’t get Crohn’s, and there are children who receive few antibiotics and get Crohn’s. So identifying risk factors is not the same as causation, but I like to focus on what can we do, because it’s sort of, you know, the horse is out of the barn, right? You have this disease, what can we do? But this is where asking that question “why?” is still so important. Because then you can follow those crumbs backward to try and put the horse back in the barn as you have so brilliantly done. I just want to finish up with that thought, I know what I know and I’m able to help people put their Crohn’s and ulcerative colitis into remission using food as medicine with a success rate that far exceeds the biologics out there because of people like you. Because of incredibly generous people who have been willing to share and to teach me about what works. You do things with your diet, and I scope you and I’m like, okay, it looks fantastic. And so I really just want to thank you on my own behalf for all that I have learned from people like you but also for you generously sharing your story here. So, thank you. So let’s go back now to what you said about when you saw the video of somebody who has a fermented food business, and she has Crohn’s disease. Is that right? So tell us a little bit more about that.
Yeah, you know, so this was just within the last year, and I was trying to tweak my diet even more because as you and I have discussed, I went back and had a colonoscopy and I did have some ulcerations on my colonoscopy and not super concerning, but the thought process was what am I going to do about this? And so I was researching some other options, and you know, ferments was something that I wasn’t really delving into at the time. And I’m watching this video and I’m watching this woman who had a very similar story in that she was conventionally raised and had a father I think who is a physician. But what she said on this video that really spoke to me is she said, I was told by many physicians that food didn’t matter. And you know, I was sitting in my study, there was no one around me, but she said that, and I just started bawling. I just started crying spontaneously. A very strong response because it spoke to me so truly to know that someone else had felt that way for years and years and then also motivated themselves to make a whole business out of it and change minds and lives. I mean that’s something that I admire so greatly. But it just really spoke to the fact that this is happening to everyone. And I really felt in that moment that I’ve got to do something about this. I want to help people. I want to show what we can do, you know, to the extent I want to help families with their children. You know, you talk about the why. And you know, one of the whys is we’re in an autoimmune crisis in our country that feels unstoppable. And you know, the what is easy to put in a randomized control trial to figure out what medicine we use, what’s causing this, but the why is really hard to study.
Well, you’re absolutely right about it being a crisis. One in four Americans have at least one autoimmune disease, and many people have multiple. So if I look at my Crohn’s patients, they often have Crohn’s plus eczema or psoriasis. And we know that in the last few decades, our genes have not changed. But what has changed dramatically is the environment we live in, and particularly the food environment. We are eating food that did not exist a few decades ago, and that, quite frankly, doesn’t even qualify as food based on my definition of something that nourishes you. We are eating shelf-stable food that is full of emulsifiers and artificial sweeteners and preservatives, and there’ve been some really interesting food studies. There was one showing that a lot of the emulsifiers, and by emulsifiers, I’m talking about that stuff that they put in food to give it a uniform texture. It’s not that different from what they put in paint to keep the pigments from separating. So it gives it that nice uniform consistency. And one study showed that those emulsifiers are strongly linked to Crohn’s flare-ups. So I think the thing that has changed so dramatically is the food that we’re eating. And again, not just one direct straight line, but it’s a huge contributing factor. And then we have other data like the hygiene hypothesissuggesting that lack of exposure to germs and nature and soil and animals, as we’ve all moved from the farm to the factory setting in a more industrialized setting is another thing. So these are some of the things that we can change. We have some compelling evidence in the Crohn’s and colitis world that rurality, meaning exposure to rural areas, to farms and animals, etc., is protective. So even if you live in a city, there are things, you can do: go out in nature, literally hug a tree, sit in the grass, even if you don’t have a dog, because trust me, that’s a lot of work, but you can have your kids exposed to neighbor’s dogs and things like that, but exposure to nature and to rural settings is protective in the scientific literature. There’s scientific data for that. Cutting out ultra processed food is protective. So these are things you can do. So tell us a little bit, I know you have two children, tell us a little bit about your approach to diet, what has worked, what are the goals, highs and lows, trials and tribulations, we want to hear it all.
Well, it started, I think, I was eating “healthy”, I think, even from the start of this, and I really did change and try to incorporate more plants in my diet sort of right away, make sure that I was doing that baseline. But I can also say that I was using standard salad dressings and things that do have gums and emulsifiers and all kinds of other ingredients, I mean shelf-stable foods. And then I think really around 2015, when I was pregnant with my second child, was when I really started thinking about what does organic mean? What does eating locally mean? Why is that important? What are the nutrients that I’m getting from my foods? And that was sort of a new evolution of the journey. So this is many stages over many years, as we’ve talked about with other things, it’s not just a quick thing. And that was when I really started cooking my own food. And so, I think that’s really where I am right now. So I’m almost no gluten. And I think that’s mostly because of the inflammatory processes of our modernized gluten. It’s not because gluten is the enemy, but you’ve talked about that before. Sprayed with glyphosate. And it’s in a lot of processed foods. And then low sugar or alternate sugar options. So flavoring things with maple syrup, coconut sugar, those types of things, but minimal, very minimal. And then very minimal dairy. And those are just the big things, hitting the low hanging fruit, the big inflammatory foods that people eat or have the most reaction to. But then separately from that, I think we really need to talk about how we feed our families, because the other thing that really has upset me for the last 12 years that I’ve been a mother is that the only thing that we can think of to feed children are little orange crackers shaped like fish. And going to a birthday party and having an ice cream bar with eight bowls of candy that my child can choose from and watching these other children just heap their bowls with this chemically laden stuff and trying to navigate that because of course my children want to go to the party and have the Skittles. You know, I don’t want to be an ogre about this, but I also want the environment that my children live in to have the choices within them to be relatively stable and nourishing and not me having to be the meanie always, you know, having my friends and parents kind of roll their eyes like, oh, Janet’s coming, you know. I don’t want it to be that way. So how can we change that environment to really inform people about what it is that we’re eating.
And it’s such an important point you make about that being sort of the cultural context because what it has done for the kids is it has really kind of cemented the idea that high-sugar junk food equals fun. If you’re not eating high-sugar junk food, you’re not having fun. And we see the same thing on the adult side with alcohol, right? If you are not drinking, you’re not having fun, whether it’s a football game, a brunch, a picnic, a party, an anniversary. Whatever it is, it’s fueled by alcohol. And so that creates this association for people, so that they can’t imagine that they could have a good time without alcohol. And we see the same thing with the idea of a treat – which always implies something that’s sugary and not good for you. You know, a treat is not an apple in our current cultural context.
But I think what is so funny is when I walk away from any kind of neighborhood get together that we’ve done or anything, I mean, what the kids are saying, they’re like, Mom, remember when we played catch the firefly and we ran around, and we were hot and sweaty and then we stayed up till nine o’clock at night. That was the best time. They’re never talking about the cupcake we got from the local grocery store that was four times the size of their head, that was riddled with sprinkles on top. I mean, I think that’s really where we’re not making that connection and where we need to be making that connection.
Do you see why this woman is my soul sister, by the way? Are you hearing why she’s my soul sister? My daughter would say: “Yeah, her girls are going to be in the support group with me later”. But that’s not true – that their mother made them eat kale for breakfast. That’s not true. But I’ll tell you, your girls have a lot of extracurricular activities, and you make and pack the food for them, and you are looked at as some kind of freak by the other parents and that is so wrong.
As I’m walking into the dance convention with my crock pot, I do all the meals. We eat 100% out of our hotel room when we’re at a dance weekend or whatever. You have to do it. It’s a lot of work and it’s a lot of prep, but the reward is so big. What it’s really doing for me is it’s fueling and motivating my diet journey. Not to have food fear, not to think you can’t do that. Certainly, someone might walk down the street and see that I’m eating a package of Simple Mills crackers because I was starving and that was the only thing I could do. I mean, we all do this, we’ve talked about this, but, you know, 90% of the time it is cooked from home, it is thought about with care, and that’s really what we need to be doing.
And the processed food is really the biggest thing that I would say we need to start with. And not just for people who have autoimmune diseases or any kind of chronic disease, for all of us, how we nourish ourselves, what we put in our bodies is arguably the most important decision every day. And it’s the thing we spend the least amount of time thinking about, but particularly for somebody with a chronic disease, whether it’s heart disease or a neurological problem. I’m on the heels of the gut brain series where we talked about Parkinson’s and autism and things like that, or for an autoimmune disease like Crohn’s, it’s particularly important. So what advice do you have for people out there who are struggling with an autoimmune disease, who are busy, who maybe like you have jobs and kids and family obligations? How do you get started down this journey?
So I would say, first of all, don’t be too hard on yourself. One step at a time, you know. And pick something that’s big and easy. Like we talked about – like diet sodas or any soda, really, or the artificial sweeteners. If you can say starting now, this is one thing that I’m going to cut. And you know, little steps leads to bigger step leads to bigger steps. You know, the other option that when people come to me or talk to me that I give people is you can put yourself in food jail for a little while if that feels better to you. You can start with a plan that’s no gluten, no dairy, no sugar, and get an accountability partner and for 30 days just do it. And you know, that also is a way. That’s actually how I really cut a couple of those big inflammatory foods out at once. My sister came to me and said, hey, I’d like to try this. And P.S., I think it’s probably good for you too. She actually was trying to cure her eczema, which she did. She had 10 years of really debilitating hand eczema that was really bothering her. And we did that together and her eczema got better. And my Crohn’s obviously was good already, but I think I took it to the next level. So little steps is the first thing. And then I also think, too, one thing that people really say to me is the cost. They say, well, all organic or these types of things is really difficult. And I say, you know, that is true, but when you take away the processed foods, you can buy a whole lot of organic broccoli for the same amount as the cost of three bags of chips. So you really have to look at that. And then separately, I would say I could probably count on my hands 50 friends that have gone to Disney World on a very expensive family vacation, which that’s great and wonderful. But if you are able to spend that much money on a leisure activity and you’re trying to cut back your costs on the single most important thing, as you mentioned, what is going into your body, I would say that that needs to be at the top of your budgetary list and everything else needs to be secondary to that. So for me, that’s really how I feel about my approach to food.
I think part of the struggle for people is that this is not the message you’re getting from the conventional medical community, or quite frankly, the alternative medical community sometimes too. It’s like: “Oh, it doesn’t really matter what you eat. Here’s six hundred dollars worth of supplements I can sell you”. So healthcare practitioners all over, I mean, there’s some fantastic ones out there, but the general message is food doesn’t really matter that much, here’s a medication, whether it’s a prescription or a supplement, whatever it is, here’s the hack, right? Here’s a conventional pharmaceutical hack or here’s an alternative medicine supplement hack. And so for somebody who already feels daunted by this, now they’re like, well, my doctor says it doesn’t matter what I eat. So I think the first step is believing. Believing that you have the power to change what is going on in your body. It doesn’t necessarily mean that you are gonna be able to put your autoimmune disease into a complete remission or cure your cancer or get up out of your wheelchair and walk – although my friend and colleague, Terry Wahls with MS did just that. So there are plenty of examples of that, but you have the power to improve your health. And whether that’s a small improvement or a huge improvement, that power is within you. And I think that is the first, I mean, not to sound sort of evangelical about it, but that is the first step. And I think so many people don’t take that first step because they don’t truly believe it. And because not only has it not been reinforced by their doctor or nurse practitioner, but it’s been poo-pooed. I see patients all the time who tell me, oh yeah, my gastroenterologist said that’s a total waste of time. Food doesn’t matter. Exactly what you were told. It doesn’t matter what you eat, except that this is now 2024, you know, and we have all the data, so much data showing that this stuff does profoundly matter. So I think that is an additional challenge. And that’s why I’m so evangelical, if you will, and so passionate about putting the information out there. And so grateful to people like you who are willing to come and share and be generous. I want you to talk a little bit about what your timeline was. The trajectory for when you started to see improvement and realizing that everybody is different. But we had somebody on a few weeks ago – another friend and colleague, a surgeon – who talked about his experience with his son with autism. And he said it really was years before they noticed improvements in his stool, improvements in his eczema, and ultimately improvement in his cognitive function and things like joint attention, etc. So for your Crohn’s journey, tell us a little bit about what that was like, the trajectory from when you started to make changes and what you started to see and how you started to feel.
Well, yes, I can definitely talk about that. And first of all, kudos to you for swimming upstream for the last 30 years against conventional gastroenterology and really giving us options for looking at things another way. So I’m very grateful to you for that.Over the course of time, I think that, you know, there was ebbs and flows of this as there often is. I mean, I was in a relationship that was not thriving and during that time I also had children. So again, making the point that I didn’t start at one end and get to the other and have this uphill trajectory the whole time. It really has taken time. So, you know, the first 10 years, I think I was probably pretty latent after I had my initial surgery. We didn’t really talk about that, but in 2007, early 2007, I ended up having a resection of my small bowel for a part that just was never going to get back to normal. It was diseased. It was obstructing. I was never going to get that part of my bowel back, so that got taken out. And then for that 10 years it was probably pretty latent, actually, and I had some pregnancies during that time, and so that also helped. I think when I really started making the changes between 2010 and 2015, I saw some changes there. But then really, I’m going to say in the last nine years, when I’ve really taken my family nutrition into account is when I’ve really felt just like my skin is great, my hair is doing well, like even external things that don’t really matter in terms of Crohn’s disease, but just sort of my overall body like how I feel, how I sleep, how my bowel movements are. All of those things have really had an upward climb that have just been really great for me.
And I will say that every time I see you, I am struck by just how incredibly healthy and joyful and glowing you are. My old mentor, Dr. Henry Janowitz, was taught by Dr. Crohn, and he taught Dr. Sachar, who was my chairman at Mount Sinai. I had the good fortune of spending a few months as Dr. Janowitz’s fellow. When I was a first year fellow, Dr. Janowitz was already in his late 80’s in Dr. Crohn’s old office at his desk. And I remember he would always say, when he saw one of his Crohn’s patients who was in remission and looking and feeling well, he would always say: “Well, I wouldn’t pick you out of a lineup”. So I definitely would not pick you out of a lineup. I mean, you just have this glowing, bursting with health and vitality look. Janet has the kind of look, you guys can’t see her, but you would see her and say: “I want some of what she’s got going, whatever it is she’s doing, I want some of that”. So now you know what it is she’s doing. And so I love that not only has this helped to put your inflammatory bowel disease into a manageable state, into a state of remission, but all these other things, some of which are probably unquantifiable, but you just feel good.
Oh yeah, and once you start making these changes, it doesn’t feel like work. I think that’s the other thing. When people listen to my story or I tell them what I’m eating, they think, oh, well, that sounds kind of miserable. I’m like, it’s not miserable to me. This is how I eat, this is wonderful, I feel great, I’m watching my children thrive. You know, one of my daughters had some bowel issues you know, and I had her keeping a stool journal and she’d rate her stool every night on the Bristol chart, and we’d write down how many bowel movements we had a day, and I did think, I’m like, Robynne would love me right now. But yeah, so you know, it’s translating to everything. It’s not just the Crohn’s, it’s really about globally how am I feeling and globally what am I doing to make a difference for my health and diet, and for people around me. I want to talk about this. It’s like there’s also a messaging of like, oh, don’t be with Janet. You’re going to have to talk about lettuce and cauliflower all day. But it’s really fun and it does taste great. That’s the other thing I tell people is that plants do taste delicious. When I’m chopping six different vegetables for my family to put in a dish at night, I feel wonderful about that.
As well you should. The best medicine for sure. But so often you do get that sort of – I don’t know if scorn is maybe too strong a word – but you get that judgment. And I think so often when people (and now I’m talking about not necessarily people who are dealing with a chronic illness, but just people in the community) see somebody who’s doing something differently, whether they are not drinking alcohol, whether they’re exercising regularly, whether they’re eating really healthfully, maybe doing all of the above, it can serve as a little bit of a mirror for them. And then they feel like, oh, I feel a little bit judged, or it makes them think about how they’re living and what they’re doing and maybe not feel so good about that. So one of the things that I love about your approach is that it’s very joyful, and it’s not judgmental at all. And it’s also like, just do something small. Like, I remember you telling me about the conversation you had with somebody in your community, and you said, just pick one thing. And you guys landed on, I think it was diet soda and maybe the drive-thru. And those things will make a tremendous difference. So the goal is not perfection. The goal is improvement, but particularly for our children, because what we are doing to our children with the food is really criminal. And you know, you think about the budget of a company like Kraft or McDonald’s versus the budget to teach children about the benefits of eating healthy fruits and vegetables. Like there is none. It’s a tiny fraction. And so we really have that responsibility.
And I think people who are in this healthcare space, depending on the age of their children or the group they surround themselves with, they don’t really think about what’s going on in mainstream America. And I’m a suburban mom. I live in the suburbs. My kids are doing regular activities. We are out in the community doing our thing. And I can tell you, sadly, that there are not people making the changes that you would hope would be being made for our kids. And so that’s really a mission. We’re talking about autoimmune disease today, but it all overlaps. It all overlaps.
Why do you think that is? Is it because they don’t know? I mean, we’re generally talking about a sort of well-heeled demographic. Well-educated. Do you think it’s because the messaging from these products is so strong?
I think it’s messaging. I think it’s groupthink. You know, I’m really into this book. I’ve told you about it already. The Anxious Generation by Jonathan Haidt. And he writes in his book at the very end, he talks about this 1960s sociology study where they brought people into a room and were told to fill out a survey. They were gonna go do a study, but while they’re waiting in the room, the waiting room starts filling with smoke. And so there were three control groups. And the first one was individual. So they found the people who were individually in the room. When the smoke came in, they went and told someone right away. But the people who were in a room with other people were looking around and it took the first person four minutes before they went and told someone because when you’re in a group, it’s much more easy to accept the status quo or think, well, it’s not bothering them, maybe it shouldn’t be bothering me. And I think that applies to electronics. We’ve had this talk before with kids and I have a whole other soapbox about that, which I will not go into today. But it also really applies to also what we’re feeding our kids. The standard thought is I need to have something bigger and better than the next guy. My children don’t play soccer, but I was talking to a friend at the bus stop whose child plays soccer and she talked about the pressure of the snack. I said, well, what about an orange slice and some water out of a paper cup and a water cooler? She said, oh no, now it’s a string bag with a six-pack of Oreos and gummies and a little toy and I just kind of lost my mind. I thought, you know what, not only are we teaching our kids they need to be celebrated for everything, but we’re also showing them they need to celebrate with six Oreo cookies, which no one should be even be eating one Oreo cookie.
There’s another wonderful book written decades ago, Doris Lessing “Prisons We Choose to Live Inside”, a slim book, maybe 60 or 70 pages about the group mentality and group validation. So everybody’s doing it, how bad can it be? At my daughter’s school, she’s in college now, but when she was in elementary, middle, and high school, all the same school, shall remain unnamed, vending machines with candy. They provide a wonderful healthy lunch. They have a chef, it’s superb food. And there’s also snacks, apples, and so on. So why do you need to have vending machines? These kids are not going to die of starvation during the school day. And it’s this idea that, well, we need to have these things. Well, why do we need to have these things for the kids? So much of this, I think, is this chain validation group mentality. But back to autoimmune disease, food is medicine. One of the things I want to remind people out there is that there is no one path to wellness. For some people with autoimmune disease, the path looks like biologics, immunomodulatory drugs, steroids, those are the things that are really improving their quality of life and keeping them healthy, and that is absolutely fine. Another path looks more like what we’re talking about, and for people who are interested, I do have a course called Drug-Free IBD: Remission Without Immunosuppression. You can find it at gutbliss.com. And in that course, I go over a lot of these principles we’re talking about. It’s really a food is medicine course. And there is that path. And some people find complete remission with just that, and that’s wonderful. Some people do that, but they still need medication, but maybe they don’t need something quite as aggressive. So maybe they just need a 5-aminosalicylic acid drug, which is very well tolerated and safe, and they don’t need to be on something that’s suppressing their immune system. But I want to just reiterate that if you are somebody out there who either needs that more aggressive medication or decide that’s the path for you, that is absolutely fine. We are not judging you. My goal for you is to be healthy, but I want to let you know that there are other things that you can do, that food matters and sleep matters and exercise matters and stress matters. And as a gastroenterologist for almost 30 years, I will tell you that seeing somebody with severe Crohn’s or ulcerative colitis change their diet and I’m inside their colon, I’m looking at this area that’s ulcerated, it’s inflamed, looks like chopped up meat. And then seeing them come back six months, nine months, a year later, and this area is healed, and it looks normal, it is nothing short of miraculous. And every time I have that experience with a patient, I literally want to cry. It makes me so happy. And it is something that when I was a young doctor, I would have thought this was pure quackery nonsense. What do you mean? Changing your diet is going to heal your Crohn’s? That’s crazy talk. And so I want to tell you, as a conventionally trained gastroenterologist, it is possible. It’s not possible in every single person, but you really don’t have anything to lose, and you have lots to gain. You have nothing to lose by getting rid of soda and stopping the drive-through and ultra processed foods, etc. And I’ve seen it myself time and time again, there are lots of us conventionally trained healthcare practitioners out there who have had this experience. For me, it’s with the diseases I treat, Crohn’s and ulcerative colitis. But there are other people out there doing the work with lupus and MS, rheumatoid arthritis. So it is a little bit of a revolution in the sense that I think people are wanting to take back control of their health. And while we are thrilled as practitioners that we have these great medications out there for those who need them, there’s so many people forging that path of real empowerment through food and lifestyle and seeing huge improvements. And again, it’s not all or nothing. So if you need a little medication too, that’s absolutely fine. So I want to end on that note. And Janet, I just can’t thank you enough. I am so inspired by you every day. I’m so grateful to you for all that you’ve taught me, and I can’t wait to see what you do next.
I want to leave you with three takeaways about treating autoimmune diseases with diet.
1. Start small. Even something as simple as giving up soda can make a huge difference if you are consistent.
2. Cutting out unhealthy things like processed food and refined sugar is important, but so is adding in the healthy stuff like vegetables and whole grains and fruit and beans. So don’t just focus on subtraction – make sure you’re thinking about addition too, what you need to add into your diet that you may be missing.
3. There is no right path when it comes to treating autoimmune disease. There’s just the path that is right for you. Hundreds of my patients have been able to get their disease into complete remission using just diet and lifestyle. Some need a little bit of medication, and a few still rely on immunosuppressive drugs to keep their disease under control. But even if you are on medication, you still have so much to gain from establishing healthy habits. Dirt, sweat, and vegetables: exposure to nature, regular exercise, nourishing food – still my best advice.
So that’s it for this edition of the Gutbliss Podcast on treating Crohn’s disease with diet and lifestyle. And a huge thank you again to my guest, Janet, for sharing her expertise, her passion, her experience with us. If you would like to learn more about a holistic approach to managing autoimmune disease, check out my comprehensive course Drug-Free IBD: Remission Without Immunosuppression. You can find it at Gutbliss.com under courses. Coming up next week on the Gutbliss Podcast, I’m going to be answering some questions from listeners. If you’d like to share an experience or ask a question, visit us at Gutbliss.com and use the contact form. Love to hear from you.
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