Welcome to Dear Melissa, where I answer your questions about transitioning into or completing a Whole30, successfully sticking to your new healthy habits, and figuring out how to make this lifestyle work in the real world. Today, I’ve recruited the help of Dr. Michael Ruscio to help me explain why those with autoimmune conditions, chronic pain, or chronic infections have a harder time with reintroduction than others, and how to handle the disappointment if you find some foods are simply off-limits post-Whole30.
Dear Melissa, Before the Whole30, I had a lot of chronic pain in my joints, brain fog, and muscle pain due to Sjogren’s syndrome, fibromyalgia, and Raynaud’s syndrome. Once my Whole30 was complete, I felt better than I had felt in years: pain gone, lots of energy. When my co-workers completed their Whole30, they went back to eating “less healthy” foods and continued to feel okay. I decided to try some of my “old” foods too, but now my pain is back. I’m discouraged that food affects me so much; I don’t understand how it can make my muscles and joints hurt so much. I do plan to do another Whole30; I just feel like I will never be able to eat other foods like my friends again without pain. –Michelle, Springfield, MO Dear Michelle, I often lead off these columns with some tough love, but that’s not the right approach here. So first, let me say I’m sorry, because it’s really hard to watch other people appear to have it easier than you do. I understand, and have had to deal with this situation in my own life many, many times. Let me try to explain what’s happening, and then offer you some advice for moving forward. First, the science-y stuff. Your medical conditions are all autoimmune (or closely related) in nature. That means that thanks to some unknown trigger (often an undiagnosed chronic infection), your immune system began producing antibodies that attacked your own tissues instead of a foreign invader. In the case of Sjogren’s, your body’s white blood cells attack your moisture-producing glands. This disorder often appears in conjunction with Raynaud’s, which isn’t autoimmune but is often linked with autoimmune conditions. Fibromyalgia doesn’t appear to be autoimmune in nature either, but symptomatically overlaps with many autoimmune illnesses, and is thought to be an abnormal response to stress in the body. (Like the kind of stress that comes from an overactive immune system.) Since you came to the Whole30 with an overactive immune system, it’s not surprising that you may display a greater sensitivity or reaction to foods that are known or suspected to negatively impact the gut or immune system*—the foods you eliminated during your Whole30 program. It’s like taking a piece of sandpaper to an already scraped knee… just a small swipe can make your knee bleed, if the skin is already damaged. *Refer back to Chapters 8-12 in It Starts With Food for a reminder on how foods like sugar, alcohol, grains, legumes, and dairy impact your hormones, gut and immune system. Your co-workers, however, likely don’t have this degree of chronic stress, immune systems as hyper-reactive as yours, or the same genetic or underlying infectious issues. Which means their reactions to foods are probably not as severe or directly consequential as yours. (We’ll come back to this in a minute, though.) So yes, they can probably eat bread or cheese or a cookie, and not have an immediate, painful reaction. Their systems aren’t as compromised as yours; at the very least, their immune systems aren’t so paranoid. It’s like they’re taking sandpaper to a perfectly healthy knee… one small swipe may leave a small scrape, but it’s not going to bleed all over the place. With me so far? Your immune system is already hyper-reactive, so reintroducing foods that antagonize the immune system will have more direct and severe consequences. Your co-workers have a different stress and inflammatory context, so their reintroductions don’t have the same dramatic consequences. But hear me clearly on this: That doesn’t mean they’re not impacted by their less healthy food choices. The impact of these less healthy foods on cravings, hormones, the digestive tract, and immune system can be subtle, and they are decidedly cumulative. Which means the impact of the bread, cheese, and cookies may not be showing up immediately, but may show up after a few days, or a week, or a month of regular consumption. We see this often with the Whole30—one day after returning to old habits, people wake up and realize, I don’t feel very good any more. The impact can sneak up on you, and often people are blinded to the less healthy effects because they’re so excited to be eating their beloved foods again, and their brain is happy with the reward, and so they deliberately ignore the consequences. In a way (and this may sound crazy, and may take a little leaning into), you’re actually luckier than your co-workers, because you have an immediate and tangible response to eating specific foods. When you eat something that makes you less healthy, your body sends you a clear message in the way of pain. It actually makes it easier to avoid things that aren’t good for you, so you won’t have to wake up one day wondering why everything hurts again all of a sudden. Clear signals make it easy to stick to foods that work for you, and avoid foods that don’t. But your context also doesn’t mean you’re never going to be able to enjoy a bite of your Mom’s chocolate chip cookies ever again. Resolving any underlying gut imbalance (like fungus or SIBO) which can easily be fed by less healthy foods can help to increase ones tolerance. Working with a qualified Functional Medicine practitioner (see page 406 in The Whole30) or naturopath to get your gut back to an optimally healthy place may reduce the impact of the occasional less healthy food choice, and allow you to indulge from time to time without the major consequences you are experiencing now. You could also play around with whether adjusting the dose or frequency of your consumption of these foods affects the severity of your body’s reaction. For example, you may be able to consume a few bites of birthday cake just to feel like you’re participating in the celebration, but discover eating a whole piece creates too much pain. If eating these foods is so emotionally important that you’re willing to risk the pain that may accompany their reintroduction, then start off with very small, infrequent doses, and gradually work your way up until you find a threshold that works for you. (Just know that those with autoimmune conditions have the highest incidence of problems with gluten, so you may need to practice stricter avoidance with gluten-containing foods.) However, knowing you have an autoimmune condition (and several related conditions), to be blunt, you’re better off avoiding these foods altogether. Even if you can “get away with” a smaller or less frequent dose, you know that these foods aren’t healthy for you in your current context, and continuing to aggravate your immune system (even to a small degree) isn’t helping your cause. Now, the wrap-up, and some tough love (heavy on the love). First, if it’s any consolation, with time, your association of pleasure and enjoyment with these foods will likely change as you notice a continued regression after eating them. It’s likely you’ll find these foods less appealing over time, should you be unable to increase your tolerance for them as described above. That means that as your body gets used to the idea that these foods aren’t healthy for you, you’ll desire them less, and will find it easier to derive pleasure from substitutions that don’t come with the same negative consequences. Finally, is this fair? Nope. But nothing is, really. We are all blessed in some areas and challenged in others, and this is your reality. You can rail against what is, spending precious time and energy fervently wishing it wasn’t, but that’s not going to do a darn thing but make you feel powerless and miserable, because wishing it wasn’t won’t change a thing. Or, you can accept that this is your context, “what is” for you, and choose to retain your power by dealing with it directly and purposefully, creating new habits and behaviors based on the foods that you know make you more healthy. You’ve come so far in the last 30 days, using the Whole30 to learn about yourself, and how food interacts with your body. You have to be a very strong and powerful person to have come this far. So I have all the faith in the world that you will decide to take what you’ve learned, difficult though it may be, and move forward with strength and commitment to continue to do what is best for you and your health. I wish you all the best. Melissa xx
Got a question for Melissa? Submit it using this handy form.
Remember, we aren’t answering questions about the Whole30 rules via this column (use the forum!), nor are we able to offer you specific advice about your medical issue, health condition, or body composition. 
Melissa Urban is a Certified Sports Nutritionist, and the author of the New York Times bestselling book It Starts With Food and The Whole30: The 30-Day Guide to Total Health and Food Freedom. She has been featured in the Wall Street Journal, Details, Redbook, and Woman’s World as the co-founder of Whole9 and the Whole30 program. Melissa lives in Salt Lake City, UT. Header photo credit: Taylor Gage, She Thrives Blog. Bio photo credit: Jordan Ison 
Michael Ruscio, D.C. is a Functional Medicine Practitioner and Doctor of Chiropractic, and a continuing education provider for the National Academy of Sports Medicine and American Council on Exercise. Dr. Ruscio has performed extensive post-doctoral Functional Medicine studies with educational bodies such as The Institute for Functional Medicine, The American Academy of Anti-Aging Medicine, Kalish Research, and Defeat Autism Now. In addition to being in private practice, Dr. Ruscio also researches and lectures nationally to doctors and students. Read more of his articles on digestion, thyroid, autoimmune conditions, and functional medicine at DrRuscio.com.
