The Most Important Lifestyle Factors for Autoimmune Disease

Genetics play an important role in the risk of autoimmune diseases—but most genes are neither good nor bad. “Their environments make them so,” Dr. Frederick Miller, former head of the Environmental Autoimmunity Group at the National Institutes of Health, who has spent more than four decades studying autoimmune disease, told The Epoch Times.

Nadine Haberfeld, an alternative medicine doctor, agrees.

“Lifestyle and diet have played a critical role in autoimmune diseases,” she said, adding that she has observed this in her autoimmune patients. They often report improvements in pain and inflammation within the first few weeks of addressing lifestyle factors.

While medications remain a cornerstone of treatment for autoimmune diseases, lifestyle medicine is increasingly being recognized as a complementary approach to managing these conditions.

Diet: A Widely Studied Factor

One of the most studied dietary patterns is the Mediterranean diet.

In a 12-week trial involving 45 people with Hashimoto’s thyroiditis, the participants who ate a Mediterranean diet showed significant improvements in oxidative-stress markers. The change suggests an anti-inflammatory and antioxidant effect on the thyroid gland, the researchers noted. The diet has also been shown to be particularly beneficial for people with rheumatoid arthritis, with research suggesting improvements in symptoms.

Various components of the Mediterranean diet contribute to these effects, including phenolic compounds in wine, such as resveratrol, which have antioxidant effects; omega-3, which can counter inflammation; and bioactive compounds in extra virgin olive oil. The diet is also rich in micronutrients such as selenium, zinc, iron, and vitamin C. Many of these nutrients are, in fact, the focus of research into dietary supplements for thyroid and immune health.

For people who already have an autoimmune disease, a 2026 systematic review found that the Mediterranean diet may improve quality of life in conditions including multiple sclerosis and celiac disease. Evidence for other outcomes, including inflammation, was less consistent and generally of low certainty.

The evidence is more nuanced when it comes to prevention. Vincenza Gianfredi, associate professor of public health at the University of Padua, led a meta-analysis testing whether the Mediterranean diet prevents autoimmune disease in people without a diagnosis. It found a potential protective effect especially for multiple sclerosis and Sjogren’s syndrome, but no statistically significant association with the incidence of rheumatoid arthritis, lupus, Crohn’s disease, or ulcerative colitis. However, researchers rated the certainty of evidence as low for every outcome.

Another dietary approach is to remove suspected triggers.

Gluten-free diets are commonly adopted for autoimmune thyroid conditions, but in people without celiac disease, research hasn’t consistently shown that a gluten-free diet improves thyroid function or reduces oxidative stress. Cutting gluten without medical need can also mean losing fiber and antioxidants from whole grains.

Broader elimination diets are also often suggested, particularly when someone suspects that specific foods are contributing to their symptoms. Certain food proteins can sometimes look similar enough to our own tissues that they may cause the immune system to become confused, which is part of why diet can matter so much for some patients and is a great place to start, said integrative medicine doctor Dr. Sulagna Misra.

“When I do an elimination diet, I am upfront that it is very, very hard,” Misra told The Epoch Times.

To do one properly, the goal is to strip away as much as possible for a long enough period of time, sometimes even considering simple things such as drinking spring water from a glass instead of plastic and eating only foods least likely to trigger a reaction for that person. Keeping a food diary for a while can help.

“I have seen sometimes that when you take the trigger away and give the gut a chance to heal, symptoms like hives and other reactions can settle down,” Misra said, “and then you may slowly be able to reintroduce foods one group at a time to identify what the body is reacting to.”

A structured version of this approach is the autoimmune protocol diet.

The autoimmune protocol diet generally involves three phases. During the first phase, grains, legumes, nightshades, nuts, seeds, dairy, eggs, coffee, and alcohol are completely removed. Refined sugars, oils, processed foods, food additives, artificial colors, and flavorings are also avoided.

Patients are encouraged to eat nutrient-dense whole foods, including vegetables, fruits, tubers, monounsaturated and polyunsaturated fats, wild game, poultry, organ meats, and other unprocessed meats. The elimination phase can last from six weeks to six months.

During the second phase, the eliminated foods are gradually reintroduced to identify those that trigger individual responses. The final phase involves maintenance.

Implementing elimination diets requires guidance from a clinician or dietitian, as prolonged or overly restrictive diets can cause nutritional deficiencies, and following the phases correctly is important when identifying individual food sensitivities.

Haberfeld’s program takes a similar approach. It begins with dietary changes she calls “not feeding the inflammation,” removing foods that contribute to inflammation and focusing on nourishing foods and drinks. As patients begin to improve, she introduces other measures, including heavy-metal removal and supplements.

Micronutrients: What to Look At

“Micronutrients are important,” Misra said. “Vitamin D is the one I check most often, because low levels are extremely common in autoimmune patients.”

Vitamin D plays a role in regulating the immune response. A 2026 meta-analysis involving people with autoimmune diseases found that vitamin D supplementation had modest anti-inflammatory effects, including reductions in C-reactive protein and interleukin-6.

For those who are deficient, supplementation may be recommended, but more is not necessarily better. High doses of vitamin D supplements can raise calcium levels, affect bone health, and put additional stress on the kidneys. It is therefore not something to try without medical guidance and should be taken under close medical supervision with regular bloodwork, Misra said.

She also checks vitamin B12, which is essential for energy and nerve function. A deficiency can worsen the fatigue that comes with autoimmune disease. “There is early laboratory research suggesting B12 may have its own anti-inflammatory effects, but I would call that ‘promising’ rather than proven, and I treat it mainly when someone is genuinely low and/or borderline and symptomatic,” Misra said.

Gut Health: Research Is Growing

The gut and immune system are closely connected, and the gut microbiome is one of the ways they interact.

The gut is constantly exposed to a wide variety of dietary antigens, and how the immune system responds to these depends partly on the microbial composition. In a healthy gut, good bacteria help train the immune system and provide defense mechanisms against pathogenic bacteria.

This balance is often disrupted in people with autoimmune conditions. For example, people with autoimmune thyroid disease have been shown to have a significantly higher abundance of potentially pathogenic bacteria and a lower proportion of beneficial bacteria such as Lactobacillus and Bifidobacterium.

A related concept is intestinal permeability, sometimes called “leaky gut.” When the gut barrier is compromised, dietary proteins that are usually harmless may then cross into deeper layers of the gut and, potentially, the bloodstream, where the immune system may misidentify them as foreign—a plausible mechanism for triggering or worsening autoimmune inflammation.

Diets rich in plant foods and fiber, such as the Mediterranean diet, have been associated with changes in microbial diversity and the production of beneficial metabolites. Research has yet to establish whether one specific diet can restore the gut microbiome or repair intestinal permeability in people with autoimmune disease.

Movement and More: The Strongest Non-Diet Evidence

Movement is another important factor in autoimmune disease, particularly because autoimmune conditions can affect joints and muscles.

Regular physical activity has been shown to be protective against developing autoimmune diseases and can even decrease flare rates and improve function in people who already have an autoimmune disorder, as it lowers markers of inflammation.

Sleep deprivation can disrupt the body’s natural rhythms and affect the release of inflammatory proteins called cytokines. Even short-term sleep loss can increase levels of inflammatory proteins, which are markers of systemic inflammation that are often elevated in people with autoimmune diseases.

Poor sleep can also reduce the activity of natural killer cells and lower levels of regulatory T cells—cells that help keep the immune system in balance.

Sleep disorders other than sleep apnea have been associated with an increased risk of several autoimmune diseases, including rheumatoid arthritis, ankylosing spondylitis, lupus, and systemic sclerosis.

Stress activates the sympathetic nervous system, which increases the production of pro-inflammatory markers and has been shown to weaken the protective barriers in the body, increasing their permeability in areas such as the gut, skin, and lungs. Simple practices such as slow breathing, mindfulness, and relaxation exercises can help calm the body’s stress response.

Hormones: Why Timing Matters

Sex hormones, especially estrogen, affect how the immune system distinguishes the body’s own tissues from foreign substances, which helps explain why autoimmune disease often shifts around major hormonal transitions.

During pregnancy, for example, the body’s hormonal composition changes to support fetal development, and this is typically associated with a shift toward a more anti-inflammatory immune response and greater activity of regulatory T cells. This change in immune activity temporarily suppresses certain autoimmune diseases, such as rheumatoid arthritis, but can worsen others, such as lupus, which is tied to a different immune pathway.

After birth, estrogen levels drop rapidly, which is associated with a shift toward a more inflammatory immune response. This abrupt change can trigger disease flares or, in some cases, new-onset autoimmunity.

People can take practical steps when hormones appear to affect their symptoms. Tracking flares alongside the menstrual cycle can help identify patterns, while those planning a pregnancy can discuss their condition and medications with their healthcare team beforehand. Closer monitoring may also be useful during pregnancy and after birth, when hormonal and immune changes are more pronounced.

Where to Start

With so many factors potentially influencing autoimmune disease, knowing where to begin can feel overwhelming.

The first priority is controlling the disease while considering lifestyle changes that support the body alongside treatment.

“I do insist that patients see a rheumatologist or specialist who manages their specific autoimmune condition and get the right immunosuppressants started to help alleviate symptoms and stop the damage,” Haberfeld said. “This is not the end of treatment but a stopgap to quickly gain some control.”

A first appointment with a rheumatologist can take months to secure, and patients may then have to wait for laboratory results. Starting the work-up with a primary care or other appropriate physician can help gather some of this information beforehand and, where appropriate, allow treatment to begin while waiting to see a specialist.

Keeping records can also make the first specialist appointment more useful. Misra recommended tracking flares, their timing, family history, and anything that seems to have worsened or improved your health.

Seeing a specialist is only one part of the process. Patients play an active role in their own health.

“I want patients to know that healing is not in the hands of the doctor or practitioner,” Misra said. “It is in your hands.”

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