Lifestyle factors can influence the immune system and inflammation, but their importance varies among autoimmune diseases. Research has linked factors such as smoking, physical activity, sleep, stress, body weight, and diet with autoimmune disease risk or symptoms.
Some lifestyle changes have clear benefits. For example, avoiding smoking, exercising regularly, getting adequate sleep, managing stress, and eating a nutritious diet can improve overall health and may be particularly important for people living with chronic inflammatory disease.
Research is also exploring whether lifestyle interventions can help some people achieve remission or substantial improvement in symptoms. The evidence varies considerably among autoimmune diseases, and these approaches need to be evaluated for each condition.
Several lifestyle factors can affect inflammation, immune function, or the course of particular autoimmune diseases:
Smoking is one of the clearest examples. It is associated with increased risk and worse outcomes in several autoimmune diseases, particularly rheumatoid arthritis.
Exercise can improve strength, cardiovascular health, fatigue, mood, and quality of life. In many autoimmune conditions, regular physical activity is now considered an important part of disease management.
Sleep and stress interact with immune and inflammatory pathways. Poor sleep and chronic stress may worsen symptoms, although proving that improving them changes the underlying autoimmune disease is more difficult.
Body weight and metabolic health may also matter. Obesity is associated with chronic inflammation and can affect disease activity and response to treatment in some autoimmune conditions.
The evidence for lifestyle interventions is strongest when we look at specific autoimmune diseases and specific interventions, rather than “autoimmune disease” as a whole.
For example, smoking is a well-established risk factor for rheumatoid arthritis and can contribute to more severe disease. Exercise has demonstrated benefits for fatigue, physical function, and quality of life in conditions such as rheumatoid arthritis and multiple sclerosis.
Diet is more complicated. Some dietary patterns may improve symptoms or markers of inflammation, but the evidence varies considerably by disease. The effects of sleep, stress reduction, and metabolic health are also being actively studied.
Overall, lifestyle clearly matters for health and quality of life. Whether particular lifestyle interventions can substantially change the underlying course of an autoimmune disease—or help produce remission—is a more difficult question and remains an important area of research.
Physicians such as Mark Hyman, Susan Blum, and Datis Kharrazian take a broader approach to autoimmune disease. They emphasize identifying possible contributors such as diet, nutrient deficiencies, gut health, infections, toxins, stress, and metabolic dysfunction.
Rather than focusing only on suppressing immune activity, they argue that physicians should also look for factors that may be contributing to immune dysfunction. Some report that patients can substantially improve and, in certain cases, achieve remission after making significant dietary and lifestyle changes.
Many of these ideas are biologically plausible and some are supported by emerging research. However, the evidence for individual tests and treatments varies considerably, and large clinical trials demonstrating that a comprehensive functional-medicine approach can reliably produce autoimmune remission are limited.
These ideas deserve serious consideration, while also recognizing where the evidence remains uncertain.
Lifestyle and medical treatment do not have to be competing approaches. For many people with autoimmune disease, the most sensible strategy may combine appropriate medical care with attention to nutrition, exercise, sleep, stress, smoking, and metabolic health.
Lifestyle changes may improve symptoms and general health even when they do not alter the underlying autoimmune process. In some diseases, they may also influence disease activity or response to treatment.
The more difficult question is whether lifestyle interventions can help some people achieve remission or reduce their need for medication. There are encouraging reports and some clinical evidence, but the answer varies by disease and much remains to be learned.
Smoking, exercise, sleep, stress, body weight, and metabolic health can all influence health in people with autoimmune disease.
The evidence is strongest when lifestyle interventions are evaluated for specific autoimmune diseases, rather than treating autoimmunity as one condition.
Functional medicine emphasizes identifying and addressing factors that may contribute to immune dysfunction, but the evidence for particular tests and treatments varies considerably.
Lifestyle and conventional medical treatment can be complementary rather than competing approaches.
Whether lifestyle changes can help produce or maintain remission is an important question, but the evidence differs substantially among autoimmune diseases.
Dr. Hyman discusses possible contributors to autoimmune disease & the functional-medicine approach to diet, gut health, environmental factors, and lifestyle.
An accessible NIH overview of how autoimmune diseases develop, who is affected, and how researchers are working to improve diagnosis and treatment.
Dr. Hyman discusses five possible contributors to autoimmune disease—diet, toxins, gut health, infections, and stress—and describes a functional-medicine approach to identifying and addressing them.