Book Review: The Autoimmune Epidemic


The Autoimmune Epidemic by Donna Jackson Nakazawa
Bodies gone haywire in a world out of balance and the cutting-edge science that promises hope

An autoimmune diagnosis comes hand-in-hand with a cascade of questions. How did this happen to me? Why me, and why now? And what am I supposed to do next? When I was diagnosed with RA at the age of 23, these questions haunted me and were not answered adequately by my doctor. Instead, I had to set out to piece together the puzzle of my autoimmune disease on my own.

The Autoimmune Epidemic by Donna Jackson Nakazawa has been immensely informative in my quest for answers, and I believe it can be for anyone struggling to understand an AI diagnosis. This book explores the environmental factors implicated in the onset of autoimmune disease. The author posits that as the use of chemicals has increased in the past 40 years, so has the incidence of autoimmune disease. In fact, autoimmune disease has tripled over the past few decades.

The statistics quoted in the book are astounding. One in 12 Americans – one in nine women – will develop an autoimmune disease in their lifetime. Due to misdiagnosis, which often accompanies autoimmune conditions, this number is likely higher – it is quite normal for AI patients to see 6 doctors before they receive a correct diagnosis. In comparison, one in 20 Americans will have heart disease and one in 14 will have cancer. Yet, though the proportion of those who will be affected by AI disease is greater than that of cancer, cancer research receives ten times as much annual research funding. For how common AI diseases are, many people cannot name a single one.

Much of the book’s content surrounds a number of illustrative “case studies” (my phrase, not the author’s), involving both specific patients as well as specific researchers and doctors pursuing answers to the many questions autoimmunity poses. The studies and situations highlighted in the book underscore how exposure to toxins in our environment can cause our immune systems to confuse “self” and “non-self.”

There are over 80,000 chemicals registered in the US, many of which have received little research into the effects they have on the people that come into contact with them. Nakazawa proposes that just as companies are required to disclose known cancer causing agents in their products – “carcinogens” – we must also name and recognize those substances that could possibly cause autoimmune disease. She proposes “autogens.” These autogens range from heavy metals like lead and mercury to possible endocrine disruptors like BPA.

Autogens are everywhere – in our mattresses, in the air we breathe, in the water we drink. If so many people are exposed to them, then why do only some people get an autoimmune disease? Nakawaza offers a metaphor called “the barrel effect-” in the same way one drop of water can cause a barrel to suddenly overflow, so can one trigger cause an autoimmune reaction that has been building from exposure to toxins, stress, and other factors. Genetic susceptibility to AI diseases would make one person’s barrel start out much fuller than the next.

It is impossible to completely avoid all toxins and chemicals. So what is a person to do, especially those who already have autoimmune disease or know that it runs in their family? I was happy to see that the first defense against autoimmunity that the author talks about is diet and using food as medicine. She  emphasizes a whole foods, gut healing protocol. She also talks about ways to avoid exposure to known autogens. I’ve read most of the advice before from other sources – using natural cleaning and beauty products, avoiding plastic and BPA-lined cans, and purchasing organic foods if at all possible.

For me, The Autoimmune Epidemic created almost as many new questions as it did answers, begging further research and sleuthing into what may have caused my “barrel” to overflow two years ago. This book was instrumental in expanding my knowledge of how our environment affects our immune systems and it can be a helpful tool for anyone seeking to gain a deeper understanding of autoimmunity.

Six Month Update


It’s time for another update, because mid-January marks my six month anniversary of doing the Paleo Autoimmune Protocol (AIP)!

 A Quick Recap

I was taking four medications for my RA just before starting AIP. I had been mostly Paleo for two months prior. My doctor recommended I wean off prednisone due to the side effects associated with using it for too long. I had a post-prednisone flare that made my whole body achy and weak, and my fingers and wrists sore and swollen. The resulting adrenal fatigue left me exhausted and unable to get out of bed.  I think that flare helped me come to the decision to start AIP full force – I started AIP the week after. For my four month update, click here.

Current Pain and RA activity

My pain and swelling are finally getting to a point where I feel they are managed well. I say “finally” because I did not experience steady improvement over the past months on AIP – there were ups and downs, including a particularly painful few weeks in late November. That flare faded and I continue to improve, feeling the best I have since starting AIP. I use a single medication (Plaquenil). Last year (before dietary changes) I tried to use Plaquenil alone for managing my RA and it was not sufficient, so I am thrilled that AIP + Plaquenil is managing my RA well, now with consistent improvement. I take curcumin (turmeric) supplements in the morning and night, and this seems to help with overall inflammation as I continue to heal my gut. Morning stiffness is still a reality, but it’s quite manageable and fades as I get up and move around.

Energy Level

My energy is slowly coming back to me! During my post-prednisone days, my adrenal glands struggled to get back on their feet, and for months I felt fatigued and exhausted. I had low blood pressure, and would often feel light-headed and short of breath in the mornings. I didn’t feel like exercising – every once in a while I could manage a walk.

Now after six months of being dedicated to 8-10 hours of sleep per night and eating very well, I finally feel my energy coming back to me. I am able to handle activity without feeling so drained. I even started light weight lifting again, something I’ve always enjoyed. In a fit of optimism, I’ve been perusing new bikes on Craigslist in excitement for summer activities.  Having my energy back has completely revitalized my outlook toward healing – I’m so grateful to have it back!


Digestion has always been a problem for me. Unfortunately during the first few months of AIP, my digestion seemed to get worse. I quickly lost weight and felt like despite all the amazing, nutritious food I was eating, I wasn’t getting nourished. I experimented with cutting out foods high in FODMAPs for a few weeks and experienced no change. I alternately gave up coconut and starchy veggies, trying to find the key.

This fall, I began supplementing with Betaine HCL  and pancreatic digestive enzymes, as my rheumatologist suggested. She thought that low stomach acid might be a problem for me, and indeed it was. My digestion has slowly improved, though it still has a ways to go. I’ve stopped losing weight and feel like the wonderful nutrients I am eating are being absorbed.

What’s Next

If my RA symptoms and digestion stay on the road to recovery, I will likely try reintroductions in the coming months. I have no reason to rush these – I have adapted well to the restrictions –and so will take reintroductions slowly. As my energy continues to improve, I plan to invest more time in exercise and will continue to prioritize sleep. I am incorporating detox baths into my weekly routine – it’s amazing that something so simple can prove so effective.

Another future possible step for me is to meet with a Naturopath and get some functional medicine tests done to take the guesswork out of my ongoing digestive issues. I’m working on crunching the numbers to see if this can fit into my budget.

Do I want to get off my final medication? Of course! But I am not going to rush this. I want to allow my body this healing period and avoid spiraling into a withdrawal-flare by going too quickly. I meet with my rheumatologist in a few weeks and will discuss my next steps with her.

It’s crazy that I’ve gone six months without a sip of wine or a drink of coffee or a piece of chocolate – all those things that I thought I couldn’t live without. At the beginning, I never thought I would be able to commit to a month, let alone six. And I am ready to commit to much more. Onwards!

AIP Yam and Liver Meatballs


Liver. **Cue groans of dread**

I’m not a big fan of liver. It’s messy to prepare and I usually am not happy with the taste/texture that results. So why bother? The Autoimmune Protocol emphasizes eating for nutrient-density, and organ meats are some of the most nutrient dense foods around. So even though they might be a pain to prepare (in my experience), I try to incorporate them into my diet often.

I like the Paleo Mom’s idea of hiding liver in recipes to mask the flavor and texture, like her Hidden Liver Meatloaf. However, I found the recipe that didn’t hide the flavor quite enough for me. The way I was able to eat it all was by combining every single bite of meatloaf with a bite of sweet potato.

So I  incorporated sweet potato in these meatballs for further masking. I also used a smaller ratio of liver to meat – opting for a 1/2 pound slice instead of the full pound. It worked! The sweet potato and coconut aminos make these meatballs sweetly delicious, and the liver taste is barely detectable.

Yam and Liver Meatballs

2 lb ground beef
1/2  lb liver
2 medium yams, pre-baked and pureed
1 tsp garlic powder
1/2 tsp onion powder
1 tsp salt
3 Tbsp coconut aminos

Preheat oven to 400 degrees. Cover two cookie sheets or cake pans with foil. Since my kitchen is small and slightly under-stocked, I used one foil covered cake pan and one glass baking dish. Both worked!

The worst part is the first part: puree your liver in a food processor until smooth.

Add liver and rest of ingredients to a bowl and mix together. Use your hands and dig in!

Roll into meatballs and place on your pans.

Cook for around 30 minutes, or until meatballs are done in the middle.

Enjoy with some extra coconut aminos for dipping sauce.

The Best AIP Recipes to Be Created In My Kitchen So Far

I’m a sucker for a good, end-of-year “Best of ” list. They inspire me to read more, listen to more music, see more films. So I decided to make a list of my own. These are my favorite, kind of special AIP recipes I’ve made in the past six months of doing the Autoimmune Protocol. In general, I have a few easy go-to meals: they work for me, taste good, and are in my price range. But I like to try a new recipe every other week or so, experimenting with new ingredients and getting creative with adaptations if necessary. This “Best Of” list represents only a fraction of the many delicious-looking recipes I want to try. Despite being a “limited” diet, there are truly unlimited possibilities of delicious foods to eat. I so much appreciate the talented people who create and share their recipe ideas!

Best AIP Recipes to Be Created In My Kitchen So Far

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Beef and Butternut Stew

Beef and Butternut Stew from Autoimmune-Paleo – Slightly sweet and very satisfying. I made it with grass-fed stew beef from my favorite farmer.

Cauliflower Casserole from PaleoPorn – This tastes a lot like the cheesy potato bake that features in my family’s Christmas spread. It is AMAZING, and something I plan to make again if I ever need to bring a dish to a potluck.

Fall Harvest Mash from Multiply Delicious – Brought this to my family Christmas and it was a huge hit! Omitted nuts to make it AIP.

Me, eating Sweet Potato Ice Cream straight out of the ice cream maker.

Me, eating Sweet Potato Ice Cream straight out of the ice cream maker.

Sweet Potato Ice Cream from PaleOMG – An amazing treat, especially when first starting AIP and missing other treats. I simplified it to simply use sweet potato, coconut milk, and cinnamon, omitting nutmeg and nut topping. It quickly became a favorite of mine during the summer!

Moroccan Lamb Heart Stew from the Paleo Mom – I have to admit, I felt a little weird about eating the heart of a lamb. A farmer was literally giving them away at the farmers market one week, and I didn’t really think about it until I got home with a bag brimming with free lamb hearts, that it might be, I don’t know, a little sad. Beyond that, I had no idea what to do with it. Enter this recipe from the Paleo Mom. I omitted all the seed-based spices, and I didn’t have palm oil to use, which she says really makes the taste unique. Though the AIP version probably doesn’t taste like the original is intended, it was delicious. I loved the combination of apricots and olives with the delicious meat.

Vegan Avocado Ranch Dressing from Feed Me Rachel – Perfect way to spice up plain burgers and lettuce wraps, which I find myself eating quite a bit.

Dairy Free Banana Carob Pudding from The Tasty Alternative – This was a recent discovery when dealing with some desperate Christmas chocolate cravings. It’s hard to believe I’ve gone nearly six months without chocolate! Carob is an AIP-legal alternative, and I had a bag sitting around. I chose to not add any sweetener besides the banana and it resulted in a rich, delicious, creamy treat that totally satisfied my desire for the Dove chocolates given to me for Christmas by well-meaning family members.

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Coconut Flour Apple Crumble

Coconut Flour Apple Crumble from “And Love It Too” – I made this twice, once with my mom for my birthday dessert and once with friends. Delicious. Careful though – it has a high sugar content from the honey or maple syrup mixed in.