The Link Between Diet and Autoimmune Conditions
The exact cause of autoimmunity is unclear, but research suggests a mixture of genetic and environmental factors are to blame. Of these various environmental factors, experts point to diet as a likely key component.
With autoimmune diseases, the immune system mistakenly perceives the body's own tissues as foreign invaders and attacks them. There are more than 80 such diseases, including multiple sclerosis, Hashimoto's thyroiditis, systemic lupus, rheumatoid arthritis, Crohn's disease, type 1 diabetes and inflammatory bowel disease (IBD). Collectively, these conditions affect more than 24 million Americans, according to the National Institute of Environmental Health Sciences.
While management techniques vary from one individual's condition to another, evidence indicates diet can contribute to autoimmune problems, and appropriate dietary changes can help many patients find relief.
How diet affects the immune system
Sunni Patel, a health coach and founder of Dish, Dash, Deets, said all cells—including ones in the immune system—have specific nutritional requirements. If a person's diet is deficient in particular nutrients, it can impede immune function.
Ami Sheward, a registered nutritional therapist, DipION, mBANT, CNHC, said nutrition also affects the gut microbiome and barrier, inflammatory processes and white blood cell function, all of which play a role in immunity.
"Interestingly, the gut houses 70 percent of the immune response through the microbiome, and we know that diet can impact gut health and the balance/function of the microbiome," Patel said. "Dietary patterns and individual foods have associations with increased disease risk, greater risk of allergy, and impaired immune response. A number of vitamins (A, B6, B12, folate, C, D and E) and trace elements (zinc, copper, selenium, iron) have been demonstrated to have key roles in supporting the human immune system and reducing the risk of infections."
Nutritionist Resource member Victoria Hamilton, B.Sc. (immunology), DipION, mBANT, said so-called "leaky gut syndrome," medically referred to as short bowel syndrome—which can develop as a result of dietary shortcomings and bacterial imbalance—may contribute to autoimmunity.
"Leaky gut syndrome is when the barrier between the digestive tract and bloodstream becomes more permeable, meaning large food particles, toxins, pathogens and other compounds can flood into the bloodstream," Hamilton said. "As the immune system doesn't recognize these compounds, it initiates an inflammatory response against them, which can cause inflammation and a dysfunctional immune response."
Food intolerance and sensitivities can factor in as well, she said.
"In an intolerance, you cannot break down the food properly in the digestive system, which can cause damage to the gut lining and cause an inflammatory response," Hamilton said. "In a sensitivity, your immune system has decided to label this food as an enemy, and every time you eat it, and it is absorbed into the bloodstream, it initiates an inflammatory response. With a food sensitivity, as well as targeting the food group, your body can inadvertently or purposefully attack self-tissue or organs."
Many people with autoimmune conditions experience one or more food intolerances or sensitivities, which can cause various symptoms, ranging in severity from uncomfortable to debilitating. Some of the most common problem foods include gluten, dairy, soy, eggs, corn, yeast, citrus, nightshades, legumes, nuts and food additives—for example, sulfites, preservatives and colorings.
"Autoimmune diseases, such as Hashimoto's thyroiditis, multiple sclerosis, and neuromyelitis optica, may flare from eating gluten and other foods through cross-reactivity," Hamilton said. "Cross-reactivity occurs when the immune system targets a food with a pattern on it similar to the organ or tissue and mistakenly starts to target that tissue. For example, the protective myelin sheath, which is the insulating layer on nerves, is targeted in multiple sclerosis."
Can diet cause autoimmunity?
It's unclear whether diet can cause autoimmune diseases, Patel said, though some studies on rats suggest gut microbiota issues could contribute to autoimmunity.
Patel, Sheward and Hamilton agreed there is evidence the standard Western diet may contribute to the high rate of autoimmunity and other chronic conditions in certain parts of the world. Patel explained the standard Western diet is characterized as high calorie, low fiber and high trans fats and refined sugar, combined with large portions and a sedentary lifestyle; this can lead to a state of chronic metabolic inflammation. Coined "metaflammation," this condition may be the root of many non-communicable diseases prevalent in the West.
"The prevalence of autoimmune diseases is much higher in Western societies," Hamilton said. "Studies show that those countries that start to improve their socio-economic status and become more 'Westernized' are more likely to succumb to chronic illness and autoimmune diseases.
"There has been a considerable surge of people who suffer from autoimmune diseases in Western populations in recent times," she added. "Eating a Western diet is likely one such contributing factor."
Additionally, Patel said, the "hygiene hypothesis" is one potential explanation for the increased prevalence of allergies, asthma and some autoimmune conditions. However, some recent research has highlighted the role of diet and bacterial metabolites in immune system processes, including gut and immune homeostasis, inflammatory response and regulatory T cell biology.
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What is the best diet for autoimmunity?
"There is no special diet that will cure any inflammatory or autoimmune condition. However, nutrition is still important for building a solid foundation of health," Sheward said. "While drugs prescribed by a doctor may be necessary to manage inflammation and pain, the truth is that inflammation can also be efficiently addressed by diet and lifestyle changes."
Patel echoed Sheward's sentiment, acknowledging that there's no one-size-fits-all remedy. But, there is evidence specific dietary changes may assuage autoimmune symptoms and promote better overall well-being.
"It would be fickle to suggest a particular food or superfoods are positive with autoimmune conditions, as every individual's condition and response varies," Patel said. "But generally, there is evidence to support the addition of plant-based foods (minimally processed and whole foods) are a worthy welcome to the plate."
'The Mediterranean diet is generally thought to be one of the best diets for those with autoimmune disease, as it is anti-inflammatory, nutrient-dense and packed with whole foods.'
Sheward, Hamilton and Patel said, for most people, a good starting point is reducing or eliminating foods that cause inflammation, such as refined sugar, trans fat, processed meats, refined grains and alcohol, while simultaneously incorporating more anti-inflammatory foods, such as nuts, olive oil, leafy greens and other vegetables, herbs and fatty fish.
"The Mediterranean diet is generally thought to be one of the best diets for those with autoimmune disease, as it is anti-inflammatory, nutrient-dense and packed with whole foods," Hamilton said. "According to a 2018 study by Rheumatology International, the Mediterranean diet can help to reduce pain and increase activity and physical function in those with rheumatoid arthritis."
Of course, certain nutrients can be effective in combating specific conditions. For example, iodine, vitamin D, zinc and selenium can provide beneficial medicinal effects for people with Hashimoto's thyroiditis.
In general, eating a diet rich in fat-soluble vitamins, essential fatty acids and essential amino acids is beneficial, according to Hamilton.
"In addition, eating the rainbow of different-colored, plant-based foods and a variety of soluble and insoluble fiber supports digestive function and gut integrity, which is paramount in preventing autoimmune symptoms," she said. "Phytonutrients found in the plant pigments also help to neutralize oxidative stress."
The autoimmune protocol diet
Along with the Mediterranean diet, and plant-based and vegan/vegetarian diets, the autoimmune protocol (AIP) is another potential solution that has been extensively studied in relation to autoimmune conditions.
"The autoimmune protocol (AIP) is a diet designed to help people with autoimmune conditions like lupus, inflammatory bowel disease, celiac disease and rheumatoid arthritis by reducing inflammation, pain and other symptoms," Sheward said. "Many people who follow the AIP diet report feeling better and experiencing fewer symptoms of autoimmune disorders, such as fatigue and gut or joint pain. However, while there is some hopeful research on this diet, it is also limited."
In the first phase of the diet, Sheward explained, individuals eliminate foods and medications thought to trigger inflammation, bacterial imbalances in the gut or an immune response.
'Many people who follow the AIP diet report feeling better and experiencing fewer symptoms of autoimmune disorders, such as fatigue and gut or joint pain.'
Eliminated foods usually include:
- Nightshades (tomatoes, peppers, eggplant, potatoes, spices derived from peppers)
- Eggs and dairy
- Nuts and seeds
- Refined or processed oils and sugars
- Food additives
The first phase typically lasts until the person experiences a significant change in symptoms, Sheward continued. At that point, the reintroduction phase begins, wherein individuals can reintroduce foods gradually, one at a time.
"The purpose of this phase is to figure out which foods cause a person's symptoms and then reintroduce those foods that don't cause them while avoiding the ones that do," Sheward explained. "This allows a person to eat as many different foods as they can tolerate."
Duration varies, but generally, people are on it for about four to eight weeks.
As with any diet, it's important to speak with your doctor before trying the AIP.
What comes next?
There is no cure for autoimmunity in general, and no food or diet is guaranteed to prevent flare-ups or assuage symptoms of any condition.
"Unfortunately, with the very nature of autoimmune conditions, and as we don't know the causes of many of them, it would be remiss to say that diet can be the sole cure or treatment of a condition," Patel said.
However, a substantial body of evidence suggests nutrition plays some part in immune system function. Likewise, it appears dietary changes may be a helpful tool in managing many autoimmune conditions, relieving symptoms and supporting remission.
"Dietary changes can help relieve symptoms and give those with autoimmune disease strength and vitality to lead a full life," Hamilton agreed.
"It can definitely be used in adjunct to treatments to manage symptoms and the condition, and support remission," Patel said. "My advice? There is definitely a role that diet can play in managing the symptoms of autoimmune conditions and supporting remission. Work with a qualified professional and coach to support understanding the influence of diet and foods to help the condition."