Written by: Bonnie Feldman, DDS, MBA, Anna Simon, Ellen M. Martin
As awareness of nutrition and food as medicine expands, using foods as health enhancers and therapy agents has become increasingly popular. Many patients, including autoimmune patients, are following specific dietary guidelines to help mitigate symptoms, based on the growing understanding that diet and nutrition can either exacerbate or reduce symptom severity.
Mixed connective tissue disease (MCTD) is an autoimmune disorder that is considered an overlap disease, meaning it is a combination of other disorders. MCTD is characterized by symptoms similar to lupus, systemic sclerosis, and polymyositis; these three conditions usually occur one after the other over a long period of time. MCTD is a rare disease most commonly occurring in women under the age of 30.
What is MCTD?
The cause of MCTD is currently unknown, but one leading theory is that the disease is related to an immune response to ribonucleoprotein (RNP) molecules. Normally sequestered in the nuclei of cells, RNPs can become exposed to the acquired immune system when cells die and release their inner contents. Mistaking RNPs for foreign invaders, immune defenses attack normal body cells with the RNP signature. Early symptoms include swelling of fingers and whitening/numbness of fingertips. Other common symptoms include Raynaud’s phenomenon (cold hands and feet), joint pain and arthritis, skin abnormalities, muscle weakness, heartburn, and problems with internal organs. Kidney disease, neurologic abnormalities, and anemia are less frequent symptoms. Genetics may predispose people to MCTD, although it does not appear to be inherited along simple Mendelian patterns. Environmental factors such as exposure to certain viruses (which trigger the cell death that exposes RNP to the immune system) may play a role as well.
Are There Best Foods For MCTD?
Certain foods and food components may help manage MCTD symptoms. The Internet offers an overwhelming amount of diet recommendations, including the Autoimmune Protocol and Gut and Psychology Syndrome (GAPS) protocol for inflammatory diseases. While we do believe that following a diet that emphasizes anti-inflammatory and antioxidant-rich foods should help people with MCTD, we don’t believe in a one-diet-for-all approach, because MCTD affects people differently and symptoms vary among patients. For this reason, we recommend starting with some type of autoimmune-specific protocol, then personalizing it for your unique symptoms. Check out our article on immune boosting foods to learn more.
That being said, there is some scientifically backed evidence to support certain foods over others for MCTD patients. This table offers a great starting point for any MCTD patient. We have constructed this table to highlight the information on food and MCTD. In addition to scientific articles (1), we used information from Personal Remedies, which harnesses a knowledge base backed by science to suggest which foods to avoid and consume based on specific diseases. This service is offered to all and shows individual food items and supplements that are the “best” for specific autoimmune diseases and conditions, in order of strength of scientific support. Combining their guidelines with our own knowledge, scientific research, and other scholarly tables, we’ve crafted our best food recommendations for MCTD patients.
In general, following a generic autoimmune diet which broadly focuses on eliminating processed foods, dairy, and added sugar, while increasing consumption of vegetables, fruits, fish, and other whole foods may be important for MCTD patients. Iron deficiency is common in MCTD patients, so making sure to eat iron-rich foods and take iron supplements, if needed, is recommended. Vitamin D deficiency (2) is also common, so eating foods rich in vitamin D like fatty fish, eggs, and fortified foods, or taking supplements if needed, is recommended for MCTD patients. Bromelain (3) is a supplement that can reduce arthritis pain and joint stiffness. It is found in pineapple juice, so drinking pure pineapple juice (without added sugar) could reduce joint symptoms. Drinking plenty of fluids is important in keeping your body functioning optimally. If you experience gastrointestinal issues, eat smaller meals and eat only when you’re hungry to minimize stomach pain. We recommend keeping a food diary to track any potential foods that trigger your symptoms, or any foods your body responds well to.
The Worst Foods for MCTD
In contrast to these anti-inflammatory foods, there are also pro-inflammatory foods that should be avoided. These pro-inflammatory foods include processed meats, sodas, salty snacks, packaged sweets, and refined carbohydrates. Unfortunately, these foods are also easy to choose when stress eating or snacking. If you suffer from MCTD, these types of food are likely to intensify any symptoms you’re already experiencing.
Because inflammation plays a role in all autoimmune diseases and MCTD is an overlapping disease, avoiding pro-inflammatory foods is our best recommendation. In addition to these generic pro-inflammatory foods listed in the table below, there are some specific foods that might be harmful to MCTD patients. For example, too much salt can lead to high blood pressure, so we recommend limiting your sodium intake or increasing your potassium.
Conventional products have more artificial chemicals (4), which could have greater effects on those with autoimmune diseases who already have compromised immune systems.
Other Tools for Managing MCTD
Engage in Mindful Eating
Other aspects of eating are important besides the best and worst foods for your body. Eating smaller, nutritionally-balanced meals could help ease digestion and help fight flare-ups. Chewing your food slowly and engaging your jaw can help activate your robust oral microbiome and promote beneficial oral health. A key aspect of mindfulness is paying attention to your body’s short and long-term response to a food – if it stings or produces cramping, or diarrhea the next day, consider it a likely bad actor in your case.
What you drink matters too! Water normalizes the pH of mouth – healthy human saliva has a pH of 7.4. When we consume acidic foods and beverages, such as fruit juice and soda, oral pH is thrown out of balance (not to mention the additional sugar and calorie intake). When the pH within our mouths falls below 5.5, demineralization occurs, making us more susceptible to oral diseases, such as dental caries and periodontal disease. Drinking plenty of water daily can help maintain a healthy mouth pH, in addition to keeping you hydrated. When drinking tea, coffee, juice, or alcohol, we recommend drinking water alongside for optimal oral health.
Exercise, Exercise, Exercise
Staying active is incredibly important to maintain healthy living. It is even more important for those who suffer from MCTD and or other autoimmune diseases because it can help reduce inflammation and alleviate symptoms. Those with MCTD may have reduced joint motion, muscle strength, and aerobic capacity, but exercise has been shown to increase these factors 5. Exercise can take many forms, from higher-intensity training like running or playing sports, to lower-intensity exercises like walking, yoga or other movement therapies. Get our free ebook on movement therapy to explore more options!
Relax and Reduce Your Stress
Constant stress is one of the hallmarks of modern life. While our stress responses were beneficial in helping our ancestors avoid predation and other life-threatening situations, constant but not life-and-death stressors brought about by modern society can be extremely harmful to our bodies. While helpful in short bursts, our flight-or-fight responses, part of our sympathetic nervous system, can have harmful consequences when constantly triggered by non-life-threatening stress. These include triggering or exacerbating autoimmune flare-ups. It is therefore important for those with MCTD to reduce overall stress.
One of the easiest ways to do this is to make sure you are getting enough sleep. Most people do not get the recommended 7-9 hours of sleep daily, and for autoimmune patients, this can have more serious consequences. Whether taking an afternoon nap, going to bed earlier, or (if scheduling permits) sleeping later, emphasis should be on consistent restful sleep. Relaxation throughout the day is also important. This could mean an early morning workout, an afternoon yoga class, even taking 15 minutes in the middle of the day just to focus on your breathing. Figure out what works best for you and do it. Take the time to be the best version of yourself: your stress will go down, your body will feel better, and your productivity may even increase!
Mixed Connective Tissue Disease is an autoimmune disease that can affect patients differently. Following some sort of autoimmune-specific, anti-inflammatory diet may help mitigate these symptoms. What worked for your friends, family, or spouse might not work for you. Everyone is unique, so experimenting with food therapy for MCTD may not be an easy fix. Try not to be overwhelmed by all of the recommendations and information out there, go slowly and trust yourself. At the end of the day, you are your best advocate and you know your body best. Fearlessly experiment with your dietary options and be mindful of your reactions. Stay tuned for our new ebook on food therapy to learn more about what makes you unique and how to kick-start your journey to finding your optimal autoimmune specific diet.
- Mixed Connective Tissue Disease (MCTD). (2017). https://rarediseases.org/rare-diseases/mixed-connective-tissue-disease-mctd/
- John A. Reynolds, Ian N. Bruce; Vitamin D treatment for connective tissue diseases: hope beyond the hype?, Rheumatology, Vol 56(2). 2017. 178–186. https://doi.org/10.1093/rheumatology/kew212
- Maurer, H. CMLS, Cell. Mol. Life Sci. (2001) 58: 1234. https://doi.org/10.1007/PL00000936
- Smith-Spangler, C et al. “Are organic foods safer or healthier than conventional alternatives?: a systematic review” Annals of Internal Medicine. Vol 157(5). 2012. 348-366. https://www.ncbi.nlm.nih.gov/pubmed/22944875
- Hicks, J. E. “Exercise in patients with inflammatory arthritis and connective tissue disease.” Rheumatic Diseases Clinics of North America. Vol 16(4). 1990. 845-870. https://www.ncbi.nlm.nih.gov/pubmed/2087581