4 phase strategy echoes managing my auto immune diet

The current 4-phase plan to reopen from COVID-19 sheltering in place makes a lot of sense to me. It sounds familiar. Since February, I’ve been struck by COVID’s onset socially echoes my experience with earlier health challenges. On an individual level specifically, it reminds me how I navigate dietary restrictions on inflammatory foods.

The moment things change
My introduction to changing my diet as a health strategy came with breast cancer. Because I sought care from conventional and alternative providers and because my cancer was caught early enough not to be life threatening, the conversation about diet routinely figured in my care visits. Both sides of the medical aisle, as it were, agreed. How you eat has a profound–if not fully understood–effect on the incidence of cancer. It also underpins the health the body needs to withstand cancer and whatever treatments one chooses.

Diet was something I hadn’t paid much attention to beyond a ‘well rounded diet’ or ‘what do I want to cook’ kind of way. Not ever from ‘this will harm you’ or ‘this will heal you.’  That was a big change. I remember looking over books and websites, reading through materials from the oncologist. I remember:

• feeling swamped: there’s a disease-fog that arises, taking attention and energy. Every day activities suddenly take longer, easily losing focus in the midst of simple tasks. (Right, there’s definitely a COVID fog happening.)

• feeling confusion: hearing often conflicting messages about what was most important to eat/not eat; hearing these messages from a shockingly wide range of people: my doctors, experts, non-experts, relatives, clients, friends…all fundamentally well-meaning, but geez. (Yep.)

• feeling optimistic: At least this was something that I could DO, some small way of taking action against this disease. (PPE, shelter, exercise, wipe down, wash hands, wash hands, wash hands…)

Everything I put into my mouth (or didn’t put into my mouth) suddenly became part of the cancer-conversation. It was exhausting and suddenly, something that gave me so much pleasure ‘before’ was lost, blanketed by the cloud of my illness. So much grief. (Yes.)

This process extended itself as my post-cancer time turned into my auto-immune time. There were 3-4 years of recovering from cancer while continuing to feel lousy. Like so many with autoimmune conditions, it took a long time to get a diagnosis. In my case it was because we didn’t realize we were looking at a systemic problem until it got bad enough, specific enough. Even so, once things got bad, it was still over a year to have the clarity of a diagnosis. (It stuns me to appreciate just how much we’ve learned since mid-January–4 months–about COVID, and how much more we need to know.)

With my AI diagnosis 10 years ago came a new round of screening for dietary factors. This brought new rounds of altering what I ate to learn more about my particular profile. Testing and retesting; ‘running the experiment’ as I came to think of it. Change one parameter at a time; give it 2-3 weeks; and reassess. Otherwise, you can’t track what might be happening. It’s too complicated. (I learned that testing gives us a view at a particular point in time. Some tests are more conclusive than others. At best they help guide treatment and behaviors. Still the body keeps changing; life keeps unfolding.)

I remember once, early on, walking into the food store with my 18+ list of foods I couldn’t eat without hurting myself. Standing just inside the door, facing a row of aisles, feeling the pull of habit that would have taken me down a usual path. My hands dropped to my side, eyes searching vaguely. I was awash in the realization that all the foods I was accustomed to eating were on that list. “What am I going to eat?” I said out loud. In the few breaths that followed, a voice inside me said, “Everything else.” Yes, everything else.

Learning about 4 Stages
My favorite resource on this journey is The Autoimmune Paelo Cookbook, by Mickey Trescott, NTP. It’s not just that a paleo diet is a good fit for my constitution, or that most recipes are at my interest and skill level. The thing I LOVE about her book is how she conceives of dietary restrictions as something to navigate. Her system isn’t binary. She honors that what we need to eat during a flare up is not the same thing as what we might eat when our system is calm. Rather than all or nothing, she has a 4-stage approach.

Like concentric circles, the center-most phase is what to do when things are bad. Risks are high and the system is highly challenged. It’s conservative and most restrictive. As the system heals and symptoms decrease, you can expand your range to include the next layer out, and then again a third layer. These intermediate layers are strategic about bringing in both nutritional variety and pleasurable variety–feeding both the body and the soul. Her outermost layer involves all foods. Nothing is off the table. Those ‘riskiest’ foods are simply identified as known inflammatories, to be eaten with caution, probably in small doses. Her system orients to the on-going changes in the body–in and out of flare ups–as well as the decision making process we live in every day.

A New Normal?
“Everything else.” What a gift that voice was and continues to be. I’m 12+ years into altering my diet — balancing my intestinal health, my nutritional needs and my emotional needs for pleasure and good company. What has become normal for me is to take these factors into consideration. Navigating risk and benefit, critical and non-critical needs, dancing with nutritional need and the pleasure of eating — this is normal, not new anymore.

Most days, thanks to meds and my behavior, my system is quiet enough that I can cheat a little here or there. When I cheat, I try to really enjoy it: choose well, accept it – rather than regret it. If I go too far, my body will let me know. Inflammation is the way that my body reminds me of what nourishes and what poisons. I also remember that most medicine can be poisonous at the wrong dosage. It’s the dance that I’m in every day, listening to that voice inside for guidance: what’s right for me today?


As we live further into a world with COVID-19, we will move from the emergency of the outbreak/diagnosis phase into the phases of living alongside the virus. Clearly having accessible diagnostics and treatments will open the horizon considerably. In any case, we’ll walk into a future where we need to assess risks and benefits and take appropriate cautions, just as we do with better-known diseases. In further posts, I’ll focus on how how I’m making sense of the 4-phase public health approach as it applies to my practice.

I’m so grateful to all those who are working on the front lines now — in hospitals, elder homes, individual homes, social services, companies who supply critical materials. And those in labs, processing, testing, retesting, using the best of your knowledge to find answers to the questions that underpin treatment and prevention. Thank you!