Diet may contribute to the development of autoimmune disease, but it can also be a tool to ease symptoms of an existing condition or potentially reduce the risk of developing one. A key focus of using diet as a strategy for managing autoimmune disease is to prioritize anti-inflammatory foods and get adequate levels of fiber, vitamins and minerals, and omega-3 fatty acids.
Autoimmune disease and diet share some interesting connections. In some ways, adjusting diet may help mitigate symptoms of an existing disease. And diet may even play a role in disease development.
“Nutrition plays a massive role in autoimmune flare-ups,” says Caylee Clay, RDN, who specializes in nutrition for autoimmune disease. “Consider that about 70 percent of our immune system lies in our digestive tract. This alone demonstrates the deep relationship between food, digestion, and immune functioning.”
A brief personal story: About 15 years ago, I began experiencing urticaria (hives) and angioedema (facial swelling) for no obvious reason. I have allergies, but my doctors and I couldn’t identify a trigger. At random times, my eyes and lips would swell, and my skin would develop giant itchy welts nearly everywhere.
After visits with several specialists and undergoing several tests, including a bone marrow biopsy at the Mayo Clinic, medical professionals determined I had mast cell activation syndrome (MCAS).
MCAS is not an autoimmune disease itself, but it has links to autoimmunity. Increased mast cell activation has associations with several autoimmune diseases and immunodeficiency. My body was warning me that something was up, and I needed to address the issue before the problem potentially progressed to something worse.
My doctors prescribed me a litany of medications, but none of them addressed lifestyle, including diet. So, I did my own research.
I learned about the role of diet and other environmental factors in autoimmune diseases and autoimmune-adjacent conditions, including MCAS. I took matters into my own hands—kitchen, rather—and completely revamped my diet. Although MCAS doesn’t have a cure, I am now largely in remission, and I attribute this improvement to what I’ve chosen to put (and not put) on my plate.
Understanding autoimmune disease
Research is in its early stages on the connections between autoimmune disease and diet. While genetic factors play a role in who develops autoimmune disease, not everyone with a genetic predisposition for a condition will develop it. Researchers theorize that our environmental exposures, including diet, may trigger changes in the body that lead to disease.
Before we dig into the role of diet in autoimmune conditions, let’s dig into what autoimmune disease is.
Our immune systems are rather amazing. They are designed to be on the lookout for threats, including infections (hello, common cold), insect bites (darn wasps), injuries (oops, stubbed toe), and more. If your immune system detects a threat, it launches a battle against the issue.
But your immune system can act in error and confuse things that are not a problem as threats. In response, your immune system can attack cells, tissues, and entire organs. When this occurs, an autoimmune disorder may be present.
Researchers know of more than 80 autoimmune disorders, and likely more exist that we don’t yet know about. In other cases, researchers may eventually determine that existing conditions not yet labeled as autoimmune should get that label. Endometriosis is an example.
“I like to explain autoimmune disease as a ‘malfunctioning’ or ‘overworked’ immune system, where the body is attacking a part of itself,” Clay says. “I often see autoimmune disease defined as an ‘overactive’ immune system, but in my opinion, this isn’t the best way to describe what’s going on.”
Common autoimmune diseases include rheumatoid arthritis (RA), Type 1 diabetes, multiple sclerosis (MS), psoriasis, psoriatic arthritis (PsA), inflammatory bowel disease (IBD), and many more.
“The symptoms and severity vary by condition, but some level of inflammation is a common thread in most conditions,” says Emily Villaseca, RDN, and founder of Pass the Chia.
Globally 4 percent of people have an autoimmune disorder, but that stat goes up to 8 percent when looking at the United States alone. And prevalence is increasing over time.
The role of diet in autoimmune disease
Inflammation plays a strong role in the development of autoimmune diseases, and this is where diet potentially comes into play as a lifestyle factor that may contribute to either disease flare-ups or even disease development. The Western diet has become increasingly inflammatory.
However, as noted, a healthy diet may also be a way to ease symptoms and potentially even prevent autoimmune disease.
“Diet alone is unlikely to cause an autoimmune condition,” Villaseca says. “However, what we eat can play a part in inflammation levels as well as how well our immune system functions. It should be no surprise that diets high in added sugar, salt, and some processed foods are likely to make it harder for our bodies to work well.”
For example, Villaseca says, “We know that the microbiome is a part of our immune system and that the foods we eat can either help it flourish or make it weaker. A weakened microbiome allows harmful bacteria and food particles to pass through, and this can lead to everything from allergies to autoimmune repercussions.”
But diet isn’t the only part of the equation—just a contributing factor. You may be predisposed to an autoimmune disease based on your genetics. For example, variants in certain genes that you inherit from your parents may put you at risk for developing MS., but that doesn’t mean you’ll automatically develop the condition.
Instead, research suggests that, while people may have an increased risk for certain autoimmune conditions, likely exposure to certain environmental factors, such as diet, may trigger the development of the disease, potentially through epigenetic changes that dictate when genes are turned “on” or “off.”
Researchers explain this with several points:
The prevalence of genetic factors contributing to autoimmune disease has largely remained the same over the past few decades, yet the prevalence of autoimmune diseases has risen.
Identical twins, who share close genetics, rarely develop the same autoimmune diseases.
Western societies have a higher prevalence of autoimmune diseases when compared to Eastern societies and developing regions.
Of course, some of these points could be the result of more awareness of autoimmune diseases and, therefore, increased diagnoses. So, we need more research to confirm whether diet is a major contributor. But research also points to the fact that diet remains arguably one of the biggest lifestyle changes we’ve seen over the last century.
Our diets now compared to our ancestors
Ultra-processed foods (UPFs). UPFs are loaded with added sugar, sodium, preservatives, dyes, and other chemicals. Western societies added UPFs to diet throughout the 1900s. For comparison, people got less than 5 percent of their diet from UPFs in the 1800s. Nowadays, people get more than 60 percent of their diet from UPFs. These foods have been linked to autoimmune disease and somewhat to central nervous system demyelination, a precursor to MS.
Added sugar (and overconsumption of sugar). We eat 10 times more sugar than we did 100 years ago, going from 17.5 pounds per year per person to 150 or more pounds per year now. Eating too much sugar can cause immune cells to go haywire. Insulin resistance, driven by excess sugar consumption, is linked to MS, lupus, IBD, RA, and more.
Soil depletion from farming practice changes. Some modern farming practices have depleted the micronutrient content of our foods and contaminated them with pesticides and other chemicals. These factors may play a role in the development of autoimmune disease. “The immune system requires specific nutrients and lots of energy (calories) to function properly,” Clay says. “Without these, the immune system can’t work well. As a result, nutrient deficiencies can make autoimmune disease worse.”
Dietary approaches to managing autoimmune disease
“The research is clear,” Clay says. “There is no strict diet that helps autoimmune disease. Instead, it’s critical to focus on having a solid nutrition foundation.”
You may wish to work with a functional medicine practitioner, such as those at Parsley Health, to develop a plan specifically tailored to your needs.
However, Clay, who authored “Gain Control Over Your Psoriasis” and founded Autoimmune Eats, shares some examples of what a solid nutrition plan might look like.
Eat more fruits and veggies
By their nature, fruits and vegetables are anti-inflammatory. They contain antioxidants, which combat oxidative stress, a contributor to autoimmune and other diseases. Clay recommends filling half your plate with these powerhouses at each meal.
Get adequate fiber
Clay recommends getting at least 25 grams or more of fiber per day. Fiber supports the gut microbiome and, therefore the immune system. Upping your intake of fruits and veggies helps you get more fiber, but you may wish to add supplements like psyllium husk. I’m a big fan of basil seeds mixed in my morning smoothie or even just a glass of lemon water.
Boost intake of omega-3 fatty acids
Omega-3s help combat inflammation, and research shows these nutrients may be helpful for preventing or managing autoimmune disease. Clay recommends adding fatty fish twice a week to your diet or taking a supplement. Flaxseed is also a good source.
Reduce intake of UPFs
Evidence shows that UFPs contribute to a host of health conditions, including autoimmune diseases and flares. Instead, you may wish to focus on getting most of your meals and snacks from whole foods or foods that are as close to their natural form as possible.
For example, a cooked potato is better for you than potato chips. That doesn’t mean you can never eat another potato chip, but limiting UPFs as much as possible may help you feel better. By reducing your intake of UFPs, you will also reduce your intake of added sugar and other additives.
Limiting sugar
Sugar drives inflammation, and overconsumption of sugar shares links with autoimmune disease, contributing to both their development and worsening symptoms.
Maintaining adequate levels of micronutrients. Our body needs certain vitamins and minerals for optimal function. Together, these are called micronutrients.
“Research clearly demonstrates that people living with autoimmune disease are often deficient in [nutrients], such as zinc and selenium,” Clay says. “There is further research demonstrating that being deficient in vitamin D can lead to new onset autoimmune disease. Maintaining adequate levels of vitamin D well within normal limits is crucial for anyone looking to avoid developing an autoimmune disease or further autoimmune diagnoses.”
A knowledgeable clinician can help determine if you need any supplements and recommend which ones and their appropriate doses to support your micronutrient needs, which may be unique to your existing conditions.
What about the autoimmune protocol (AIP) diet?
As part of your treatment plan, a health care provider may recommend the autoimmune protocol (AIP) diet, which involves temporarily eliminating certain foods before slowly reintroducing them to see if the foods trigger your symptoms.
You should only undertake this diet under the supervision of a knowledgeable provider who can ensure you are getting optimal nutrition.
“Very importantly, any kind of elimination diet should not be a forever thing,” Villaseca says. “Our goal as clinicians is to find what may be triggering your health issues and then liberalize your diet again as much as possible.”
Since research is limited on whether this diet is effective, some clinicians will avoid this intense elimination diet altogether, opting to look at suspected foods individually instead. This avoids unnecessary dietary restrictions.
“Once a suspect food is identified,” Clay says, “we then find acceptable alternatives. For example, if gluten is suspected and they love eating sandwiches, we'll find a gluten-free bread that they like. The next step is to avoid this food for four to six weeks and see if symptoms improve. If not, reintroduction is generally very simple and easy.”
Maintaining a healthy relationship with food
When using diet as a management technique for autoimmune conditions, maintaining a healthy relationship with food is crucial.
“There is a growing body of research indicating that people who live with autoimmune disease have a much greater risk of developing eating disorders, such as anorexia and bulimia,” Clay says. “Strict diets are another known risk factor for eating disorders. Eating disorders are extremely serious conditions, with a low recovery rate and high mortality rate.”
For these reasons, an additive approach, rather than one that subtracts foods from your diet, can help.
“We generally can only eat so much food in one day,” Clay says. “By focusing on what you should eat more of, you will naturally start to improve the quality of your eating habits. This also supports and maintains a positive relationship with food and our bodies, plus improves autoimmune disease outcomes.”
Key takeaways
Diet may play a role in the development of autoimmune disease, potentially as a triggering factor for people who already have a genetic risk.
Diet can also be used as a strategy to ease symptoms of an existing autoimmune diagnosis and reduce your risk for developing certain conditions.
Dietary strategies that may help include prioritizing anti-inflammatory foods and getting adequate levels of fiber, vitamins and minerals, and omega-3 fatty acids.
A Parsley Health practitioner can customize a diet and treatment plan for you. Reach out for a free consultation.
FAQ
What is the best diet for an autoimmune disease?
A diet for autoimmune disease is highly individual and depends on which condition you have, your symptoms, your unique preferences and needs, and more. But, in general, a diet that focuses on reducing foods that contribute to inflammation and adding anti-inflammatory foods can help.
What is the root cause of autoimmune disease?
Researchers don’t yet know the exact causes of autoimmune diseases. But likely both genetic and environmental factors play a role.
How to calm an autoimmune flare?
If you are experiencing an autoimmune disease flare, consult your health care provider for what to do.
Do you get sick more when you have an autoimmune disease?
Autoimmune diseases affect the immune system, and you may need to take certain medications that suppress the immune system as part of your treatment plan. For these reasons, having an autoimmune disorder may make you more susceptible to certain illnesses, such as the flu, common cold, and other viral or bacterial infections.
Is autoimmune disease linked to diet?
Although diet alone does not cause autoimmune disease, research indicates that diet may trigger changes in how your genes are expressed, which may lead to the development of autoimmune disease, especially in people who have existing risk factors. The Western diet has changed dramatically over the last century and may have connections to autoimmune disease. Eating a more anti-inflammatory diet instead may lessen your risk and may also help with managing an existing autoimmune disease.
How to live a healthy life with an autoimmune disease?
Even if you have an autoimmune disease, you can still live a healthy life. Working with a knowledgeable clinician will help you determine the best strategies for your unique situation. Strategies may include medications and supplements, getting adequate sleep, managing stress, increasing exercise with activities tailored to your needs, and altering diet to take an anti-inflammatory approach.
